Friday, February 8, 2013

Increasing Accessibility: Complimentary Midwifery Care

In the past year, I have had the privilege to attend several births as a student midwife and I can honestly say that each experience has touched me in a special way. I can recall dancing with a woman as she swayed to the rhythm of her contractions; I have dabbed the sweat from many a woman's brow with a cool washcloth in between her "surges". I have even felt the raw power of a woman's determination course through her body as she leaned back into my arms and pushed with all her might to bring her baby into this world. Of course, some of my favorite memories are when women have gently birthed their newborns into my hands as their family watches with pure awe and reverence on their faces as they greet their newest member. They have just witnessed not only the birth of a new baby-they have witnessed the "birth" of a new mother as well. It is moments like these that capture a mere glimpse of the intense beauty and power that make birth so special.

Pregnancy and birth are elements of an incredibly momentous journey into motherhood for a woman. This life changing event can have a profound impact on a woman and her family as each member assumes a new role in relation to the little bundle of joy-mother, father, big brother, big sister, grandparents and others. Since each member of the human race enters this world through their mother's womb, pregnancy and birth have always been normal, elemental human experiences in family life.

Worldwide, hundreds of thousands of babies are born each day-many of whom are birthed into the hands of a midwife. In fact, in most developed countries, the majority of births are attended by midwives. The United States differs in this aspect, however, as midwifery was not allowed to flourish at the turn of the 20th century. At that time, a physician-led campaign attempted to smite the entire midwifery profession, prohibiting many midwives from practice. The shockwaves of this campaign are still felt to this day. Based on a 2010 National Vital Statistics Report, less than 20% of births in the U.S. are attended by midwives.

In developed countries that have an established standard of care that provides access to midwifery care for most, if not all women, their birth outcomes are better than in the U.S. Despite the advances in technology, specialized obstetrical training and astronomical healthcare expenses, the U.S. consistently lags behind in the maternal-neonatal health care statistics. In an excerpt from her book, Into These Hands: Wisdom from Midwives, Geradine Simkin, the Executive Director of Midwives Alliance of North America, tells us: "The U.S. has one of the highest infant mortality rates in the modern world, ranking about thirtieth among developed nations, and the rate is higher for infants of color. Although the U.S. maternal mortality rate has improved over the past century, it has not improved at all since 1982 and appears to be increasing. Our maternal mortality rate is as dismal as some developing nations and the rate is higher for women of color. The safety, reliability, price and performance of our current maternity care system are issues of grave concern." It is clear that the highly interventive, over-medicalized approach to care of women during pregnancy and birth that is so prevalent in the U.S. is not improving outcomes for mothers and babies. What is it about integrating open access to midwifery care into the healthcare system for all women that improves pregnancy and birth outcomes?

Midwives respect the normalcy of pregnancy and birth as a healthy part of the life cycle for women. Throughout the childbearing year, midwives provide holistic support and address concerns regarding the woman's physical, emotional, and social well-being. While providing hands-on support and monitoring during labor and birth, midwives are also committed to utilizing the least amount of technological interventions as necessary. Midwives do not ignore the fact that pregnancy and birth can become vulnerable to pathology or complications, and are not opposed to referring to specialized providers, such as obstetricians, or using technological or pharmacological interventions when there is an indication to do so.

It is true that technological interventions can provide myriad benefits, but midwives appreciate that every intervention also introduces some degree of risk. Take cesarean section for example: cesarean section can be a life-saving tool for both mother and baby, but we cannot ignore that this is a major abdominal surgery that carries the potential for harm. Potential risks of cesarean section include-but are not limited to-hemorrhage, infection, and death. The divergent perspectives on the potential benefits and harms of routinely interventive, highly medicalized care of women during pregnancy and birth that has become the standard in the U.S. is one of the areas that distinguishes midwifery from the field of obstetrics.

The practice of midwifery is supported by a comprehensive body of knowledge regarding the normal reproductive health of women and its potential for motivating a woman to make healthy lifestyle changes. Additionally, midwives spend more time with the women that they work with from appointment to appointment, providing prenatal care and education that is tailored to the individual needs of each woman and her family. Obstetrical practice is also supported by comprehensive knowledge of the reproductive health of women; however, there is a greater focus on the potential for pathology or complications to arise and making a diagnosis. As you can imagine, there is some overlap between the practices in the two specialties which allows midwifery care to serve as a compliment to obstetrical care, when needed. This makes midwifery care appropriate for not only women experiencing healthy, low-risk pregnancies but also for women who are experiencing high-risk pregnancies that require obstetrical management as well.

There are examples of care models, both domestically and internationally, where women receive both midwifery care and obstetrical care during their pregnancy. Those care models have seen a significant reduction in the neonatal mortality rates and a decrease in the rates of birth related trauma, infections, and complications-particularly in rates of pre-term births and of babies who are born with low-birth weights.

One such example of this care model exists at The Birth Place in Winter Garden, Florida. The Birth Place is directed by Certified Professional Midwife, Jennie Joseph who established the "Easy Access Clinic" within The Birth Place where no woman is ever turned away. Through collaborative partnerships with other medical providers in the community, including obstetricians, and the regional hospital, women receiving care at the Easy Access Clinic experienced lower rates of pre-term births, low-birth weights, and cesarean section. For example, according to the March of Dimes, the rates of pre-term births in Florida are approximately 14%. For women receiving care at the Easy Access Clinic, the rate of pre-term birth was less than 2%.

No comments:

Post a Comment