• Home
  • About
  • Services
  • Contact
  • Blog
  • Testimonials

How I Became a Midwife

10/23/2016

9 Comments

 
Warning: This is not your typical midwifery blog post, a midwife's personal story is to follow. And parts are kind of embarrassing to admit lol so I hope you enjoy the candidness.

People ask me all the time how I got into midwifery. Like many midwives, I got into midwifery because of the births of my own children.
Never in my wildest dreams did I think I would grow up to be a midwife. I was raised in a middle class, mainstream, divorced family home with no knowledge of natural birth. My dad was a commercial airline pilot, and my mother changed careers many times but spent most of her career in sales before becoming a writer later in life. I grew up on mac and cheese, packaged Little Debbies, anti-biotics, vaccines, and a high regard for modern medicine. Words like natural, organic, holistic, herbal remedies, and midwifery were not in my family’s vocabulary. I also grew up deathly afraid of birth. My mother recounted her birth stories with horror. She literally said she thought she would rather face a firing squad again than go through the torture she experienced. Her first three children were born in the late 60s, early 70s and she was left alone in the hospital tied to a bed with no drugs, and given no support on how to cope. She told me her third child was stuck and that the doctors stated they may have to break her pelvis before he was finally born. Then I came along in 1976, her last child, and she was offered the new “magic epidural”. She said it was wonderful. My dad was out of town for the birth flying and she drove herself to the hospital.

So when I got pregnant at age 27, I knew I would have an epidural. That was all I knew. All of my friends that had gotten pregnant before me had done the same. Except one of my high school friends told me she had a natural birth. I remember thinking she was crazy and could not fathom why she would do that. I had also met a girl through my husband who said she had her baby at home with a midwife. That was the first time I had ever heard of home birth and at the time I was truly horrified by the thought. So being the typical mainstream young woman that I was, I picked the largest baby factory hospital around and a large practice of rotating obstetricians.

Like most first time moms, I was extremely inpatient about having my baby and thought for sure I was going to have her early. I even went to the hospital after several bouts of ‘contractions’ and losing my mucous plug at 36 weeks. They told me I was 2 cm, kept me overnight for monitoring, and sent me on my way. At my 38 week appointment, my blood pressure was slightly elevated and I had a lot of swelling in my feet overnight. They sent me over to the hospital for monitoring and more tests, stating that I may being developing Preeclampsia. At the hospital, once they had me on the monitors they stated I was having contractions 3 minutes apart (though I was not really feeling them), that my cervix was 3 cm, and that I was going to stay and have the baby. I was excited and ready to meet her so there was no argument from me. My only disappointment is that they would not let me eat the food we had just picked up on the way to the hospital and I was starving.

So they broke my water and we waited for the contractions to get stronger. At the next check they said I was 5 cm and that I better go ahead and get the epidural because the anesthesiologist was around and if I wait too long, he might be tied up with surgery. I wasn’t even in pain and but I got it because I was terrified of not getting it later. So I laid in bed for hours while they eventually added Pitocin because things had naturally slowed down after the epidural and being in bed, though at the time I was very ignorant about birth and didn’t know any of the risks of induction, epidurals, being immobile, etc. Finally that evening I was complete, but after 3 hours of pushing, and 3 pulls of the vacuum, they informed me that she was stuck in a posterior position and I would need a c-section. My daughter was born via c-section at 1:05 am, weighing in at 7 lbs, 4 oz. She was a gorgeous newborn with lots of dark hair, though she had a terrible cone head and an open wound on her head from the vacuum. It took me about 45 minutes to finally get her into my arms once they moved us to recovery and I was instantly in love.

After the c-section, I was disappointed but I tried not to focus on it much. I remember being in mommy groups with my newborn while they all told their birth stories and I felt bad when it was my turn to say I had a c-section. Why couldn’t I birth my baby like they did? I was average build and my babies were not big. My mother and her sisters all had several children and none of them had to have c-sections. While it did bother me, I also knew I wasn’t alone as several friends and cousins had already had c-sections too.

I didn’t put much thought into it until I was pregnant the next time around. At this point I had assumed I would have a repeat c-section because that is what everyone I knew had after having c-sections. I still hadn’t even heard much about VBAC except rumors of them being dangerous. However, I was scared to have another c-section because I also had a major complication with my first one where a portion of the placenta was retained, resulting in a uterine infection. I ended up hemorrhaging, spending another week in the hospital getting IV antibiotics, and had to have a blood transfusion and D&C.

During my second pregnancy, we had moved to another state and I pick a female OB in private practice based on someone’s recommendation and it was actually her idea that I have a VBAC! She stated I was a good candidate and there wasn’t any reason I couldn’t have a trial of labor. Then I got excited and finally decided to do some research that I should have done long ago. As I researched, my eyes were opened. I finally learned so much about induction risks, epidural risk, being active in labor, doulas and more. Then to my terrified dismay at the time, I discovered I might have a better chance of having a vaginal birth if I did it without drugs so that I could be upright and active…Oh the horror! I didn’t think I could do it. I am the biggest wuss I know. I decided to hire a doula and figured I would give it a shot, all knowing in the back of my head if I couldn’t take the pain I could ask for the epidural.

At 39 ½ weeks I woke up at 4:00 am to very strong contractions. I had been having contractions at night for weeks as I drove my doula nuts with false alarm calls. She kept telling me I will know and that it probably wasn’t time. She wasn’t kidding. That morning I think I had two contractions and I knew it was different. I had just been checked a couple days before and was already 5 cm so they told me it could come on fast. And it did. I immediately woke up my husband and said it was time to go the hospital. Well he did not believe me after the many nights before I had thought I was in labor. But I knew this time it was no joke and things were happening fast. We finally made our way into the car and to the hospital. Once there, I thought I was dying. My doula was at another birth and said she would have to send a back-up. The nurse checked me and as she did my water ruptured all over the bed and she said I was 7 cm. I immediately told the nurses that I needed to get into the tub which had been my plan all along and they laughed and said “You’re a VBAC, you can’t get in tub”. Oh no, now what?! That had been my main plan all along because I had heard it helped a lot with the pain. Meanwhile, my husband who still thought we had a long ways to go was off getting coffee while I was strapped in bed with the monitors thinking I was going to die. I kept trying to get up out of bed but every time that I did the monitors would not pick up the heartbeat and the nurses would freak out saying "We have to monitor the baby". That was it, I had to have an epidural. My husband laughed and said I thought you are not getting it and I thought I would punch him. I cussed him out quickly and begged the nurse for one. The nurses quickly complied calling the anesthesiologist. My back-up doula was still not there to try to talk me out of it. Once the back-up doula arrived, she saw they were setting up for the epidural. She was a stranger and did not try to change my mind and it wouldn’t have matter if she tried because my mind was made up. At this point I was feeling tons of pressure in my rectum that was unbearable but at the time I didn’t realize that meant my baby was going to be born very soon! I was in transition but didn’t realize it and feared I had many hours to go.

As soon as the epidural was in, the doctor came and told me I was 10 cm and could start pushing. The epidural was still not working (probably because it was given so late). I was flat on back and couldn’t calm down. The nurse handed me a cord with a button and said I could push it for more epidural medication to be administered which I immediately did. Finally after several minutes the pain stopped. Phew. After about 1 hour of pushing, my son was born at 8:26 am, after only 4 hours of labor, weighting 7lbs, 3 oz. There was meconium in my fluid so they did not hand him to me but passed him to the NICU nurses for suctioning. After a minute I heard him cry and knew he was fine but it took them several minutes before they finally brought him back to me. He was perfect. I was elated! I pushed a baby out of my vagina! My body was not broken. While I was slightly disappointed I got the epidural, I knew in the back of my mind all along my biggest goal was to have a VBAC, not necessarily a natural childbirth, and I knew I wasn’t fully committed to that decision and was ‘playing it by ear’.

After my son's birth, I became enamored with the mystery of birth. I was shocked at how fast and, even though painful, relatively easy his birth was. The process of going into labor on my own was an unreal feeling and I learned a lot about myself and control. The week before he was born, I tried everything in my power to get him to be born. Even though my doctor was supportive of VBAC, she told me she wasn’t comfortable with me going over my due date by much, so I did feel like I was on the clock. So I tried sex, walking, nipple stimulation, drank red raspberry leaf tea, took evening primrose oil, pushed acupuncture points, ate spicy food, ate pineapple, and much to my embarrassment to admit now, even drank castor oil. And none of it worked. It was such a life lesson to my Type A controlling personality. Birth comes on its own terms when baby and the body is ready. Even now, at each birth I am humbled as it unfolds out of my control.

Through the experience and after learning more about the mystery of birth, I decided I wanted to become a doula. I hadn’t mentioned that my first career choice was a Certified Professional Accountant. It was not a good fit for me and I was bored to tears. I had gotten into because I didn’t really know what I wanted to do when I grew up so I figured business was a good route. My grandfather, step-father, and my older sister who I admired greatly, were all accountants.

At this point, when I decided to become a doula I never dreamed I would end up becoming a midwife, though that would change as my love and respect for birth grew. So I was a stay-at-home mom and began reading more about birth, and then I attended a doula training. When my son was a year old, I had my first opportunity to attend my friend’s birth as her ‘doula’. This birth ended up being a very traumatic birth (shoulder dystocia) and it’s amazing I still ended up becoming a midwife because it scared me so bad. I thought, maybe this doula things isn’t for me after all. But the call to birth kept coming and got stronger. Of course I went home that day and spent hours reading everything I could about shoulder dystocia. It happens in about 2 in 100 births. At home birth, we use different techniques to resolve it because we can move the mom into different positions which cannot be done with a mom flat on her back with an epidural. I still feared it but knew there were ways to handle it.

Shortly after that, I did become a doula. I was blown away by women’s strength, birth after birth, and I was mesmerized with the way birth unfolded. However I was also frustrated with the cascade of interventions I saw in the hospital. Then, I had an opportunity to attend a home birth. I was still a pretty new doula and at this point, so I was still a little nervous about home birth. It was a magical experience. She waited to have someone call me until birth was close. I quietly tiptoed into her bedroom fill with 2 midwives, her doula, another friend, and her husband. She was in the birth tub, quietly breathing through contractions as her husband held her. I instantly felt I was in sacred space. Quickly her low moans changed into guttural grunts. At first I didn’t realize what was happening but then I finally realized, she was pushing! No one was coaching her or yelling at her to push, she was just instinctively doing it on her own. The midwives just sat by quietly and observed and would listen to the fetal heart rate with the waterproof Doppler turned down low every so often. She was lying on her side in the tub and announced that the baby was coming. I looked and saw she had her hand cradled over the baby’s head under the water. With the next push the baby swam free as one of the midwives gently helped her lift the baby out of the water and onto the mom’s chest. At first I was worried something was wrong because I didn’t hear the baby cry. But I saw his eyes were open and he was moving his legs and was looking straight at his mother. I later learned that home birth babies, especially water birth babies, are typically very quiet when they are born when lights are low and the environment is quiet. Soon the placenta was born and mother and baby were moved to the bed. We all enjoyed a breakfast casserole together that had been put in the oven once birth was getting close. The midwives examined mom and baby and found the baby to be a whopping 10 lbs and mom only had a small tear that didn’t require suturing. This birth was clearly life-changing for me. I still didn’t know that I wanted to be a midwife, but I had seen what sacred undisturbed birth could look like.

​After this I kept attending hospital births and got more frustrated. When I got pregnant with my 3rd child and I knew I wanted a home birth. My home birth was life-changing because I finally made it through natural birth. I had an amazing 4 hour labor in the comfort of my own home and birthed in the water surrounded by my birth team and loved ones. It was hard, but so much easier to be relaxed in my own environment. After this birth, I had an amazing opportunity to birth assist for a local home birth midwife. I was quickly called to midwifery school after that experience and the rest is history! I considered trying to stay a doula but I constantly felt called to more. I was constantly researching everything I could about birth and midwifery and things outside the scope of a doula. Being a midwife is a lot different than being a doula as a midwife requires much more critical thinking and analytical, clinical skills which seemed to be more appropriate for my analytical, type A personality. Midwifery is a calling. I tried to fight the call for a while but could no longer fight it and accepted that this was what I was called to do. It's a spiritual journey. I wanted to guide other moms through their life-changing experience, learning so much about themselves such as surrender, acceptance, patience, and the strength and power of their body like I had. I have been blessed and honored to witness so many miracles standing by women through all to the blood, sweat, and tears as they bring forth their children. And now that I am a midwife I wouldn't change it for the world.
9 Comments

What's it Like Having a Home Birth?

8/25/2016

0 Comments

 
I get this question a lot, at initial consults, couples looking into this option and asking what to expect.  Great question. 
 
First of all, it’s unpredictable.  I've never been to two births that were exactly alike, as bringing a human into the world is such a sacred, profound, personal experience, and every labor is different.  Birth is a mystery, and I soon as I think I have it figured out, it surprises me.  However, that said, there are some things that are standard with planning a home birth with Divine Birth Midwifery. 
 
First, there is the prenatal care.  This follows the typical prenatal schedule that would be similar if you were planning a hospital birth.  Appointments typically begin early in pregnancy or around 12 weeks.  Then, you have appointments every 4 weeks until you get to 28 weeks, then every 2 weeks until 36 weeks, then weekly until 41, then biweekly until delivery. 
 
So what happens at these appointments?  They last about an hour in which we get know each other.  Then, there is the standard clinical elements:  blood pressure; pulse; checking urine in a cup; palpating your abdomen to feel baby’s position, size, and fluid; and listening to the baby’s heartrate.  We also discuss any concerns you have, how to prepare for home birth, emotional and physical well-being, and determine if any risk factors have presented.  There is also lab work that is done at various points in the pregnancy and potentially ultrasounds based on desire or need and these are done at outside lab and ultrasound facilities.    All of the prenatal appointments are at my office except for the home visit which is done around 37 weeks.  At the home visit, we will make sure you have the supplies you need (list provided), deliver the birth tub if you rented, ensure that the home is ready for birth, go over plans with the birth team, discuss signs of labor, and discuss an emergency plan. 
 
Then the birth!  Once you go into labor, we will keep in close contact with you as your labor progresses.  If you hired a doula, she will come at some point once you feel you are needing more support.  Then we will come once you have been in active labor for a bit.  Some moms are not sure when they should have us come.  Typically, if you were planning a hospital birth and determined that it was time to go to the hospital, that is a good time for us to come. 
 
Once your midwife and assistant arrives, a set of vitals will be taken, and we will listen to baby with the doppler.  However, you will be able to be in whatever position you would like, including the shower or tub because the doppler is waterproof.  Then we will sit back and quietly observe to see how things are going and set up all of our supplies and equipment.  Women tend to move around in labor and may go from room to room.  So we set up our supplies on a tray so that we can easily take them to another room if that’s where you end up for birth.  You will be left undisturbed as much as possible to labor as you need to.  Many women change positions, walk around, get in the tub, whatever they need to get into ‘laborland’.  We will periodically remind you to drink something and empty your bladder if you are not doing so.  Overall, we will leave you alone to ‘do your thing’, however, we will offer support, encouragement, and suggestions if needed.  We will also periodically monitor your baby’s heartrate to see how baby is tolerating labor.  If at any time during your labor or during the postpartum period we have any concerns about you or baby’s well-being, we will transfer to the hospital or call EMS if needed.  There are typically warning signs, or red-flags that things are not going well and that we need to transfer to the hospital.  We do not routinely do a vaginal exam, it more depends on the circumstances, if doing one seems like it might give us beneficial information.
 
Next we sit back and quietly wait for you to begin feeling the urge to push.  At first you may start feeling more pressure in your bottom at the peak of the contractions.  Eventually this will build and build until you feel like you have to push with it.  At some point your water will break, if it hasn’t already, and we will assess the color of the fluid and baby’s wellbeing.  The nice thing about home birth is you can decide what position and where you would like to birth your baby, unless there is some reason we need you to do something different.  Women end up birthing in all kinds of places, on the floor, on the couch, the bed, the bathroom, the birth tub, the shower, the birth stool, etc.  They might be on their hands and knees, kneeling, standing, on side, or on their back.  Typically, once that overwhelming urge to push takes over, moms start to push and do not want to move. 
 
But don’t worry, it’s not messy!  We put large chux pads or plastic-backed paper sheeting under wherever you end up if you’re not in the tub.  And if for some reason, some mess does get on the floor or furniture, your birth team cleans it up as good as new before we go.  Hydrogen peroxide gets birth fluid up amazingly well. 
 
As your baby is being born, you can help deliver the baby yourself by placing your hands there, or the baby’s father if he would like, or your midwife will help lift the baby to your chest.  As soon as your baby is born, your midwives will observe the baby’s well-being in your arms.  Most of the time, no help is needed and your baby will begin breathing on his or her own and start looking around.  If baby does need assistance, your midwife and assistant are Neonatal Resuscitation Program certified and have the necessary equipment to assist your baby during the transition. 
 
At this point, as long as you and baby are doing well, baby will stay in your arms, skin-to-skin, during this amazing time.  A cascade of hormones are rushing through your body which aids in bonding and in the delivery of your placenta.  Shortly your baby will begin rooting for the breast, and breastfeeding initiation may begin.  In the meantime, your midwife is monitoring your bleeding and you and baby’s vitals while waiting for the delivery of the placenta.  At some point, usually within 15-30 minutes, you will start feeling cramping sensations, signaling that your placenta is ready to be delivered.  Your midwife will help you deliver the placenta and then we will get you tucked into bed (if not already there), with baby still on your chest.
 
Next, when you’re ready, we clamp and cut the cord separating the physical tie between you and baby.  You will still be left to bond with baby while we quietly monitor you both and get you food and drink.  If your bleeding gets too heavy, we are prepared to handle that.  While you are bonding with baby, we will examine your perineum and suture any tears if needed.  About 2 hours after delivery, we will help you up to the restroom so that you can empty your bladder.  Then we will do a full head to toe assessment of baby.  Once your postpartum instructions have been given, and you and baby are both stable, we will quietly tip toe out so that you and the family can rest and bond, typically around 3-4 hours after delivery. 
 
For the postpartum period we will keep in close contact with you during the first couple days by phone and return at any sign of a problem.  Then, the midwife returns after 48 hours to assess both you and baby and perform the Newborn Metabolic Screen (unless you decline).  The midwife also returns to your house 7-10 postpartum for another assessment (unless needed sooner).  Then, you and baby will return to the office for 2 more postpartum visits at 3 weeks, and 6 weeks.  This is always a bittersweet time as you and your midwife have just spent around 9 months together through this journey.  But the best is when you come back for your next baby.
​ 
Overall, what is it like to have a home birth?  No words can really describe though I’ll try.  Empowering, enlightening, life-changing, hardest thing you will ever do, sacred, spiritual, and more. 
 
0 Comments

Benefits of Natural Childbirth

11/28/2015

1 Comment

 
Before I talk about the benefits of natural childbirth I want to make a disclaimer that I am in no way judging women who choose to take a different route and prefer having medication during delivery. As women we deserve to have ultimate control over our bodies and make decisions on how we give birth.  Yet women also need to be given information regarding all choices of interventions, understanding that nothing is without risk.  In addition, I am grateful that we have access to medications and interventions that can absolutely be life-saving.  Labor and birth are mysteries that do not always go as planned, and sometimes an epidural and medical augmentation are extremely helpful in facilitating a vaginal birth and a Cesarean may be live saving.  My hope is to let women in this country know that natural childbirth is not crazy, despite the crazy looks you may get, and that there are many benefits. 
​
I remember when I told people I was planning to have a natural childbirth with my second child. I got a lot of funny looks and comments.  You know the ones like, “Why would you do that” or my favorite “Well you don’t get a medal for not getting an epidural”.  Unfortunately, this is the general mentality in the U.S. regarding natural childbirth.  But it is not about getting a medal. There are many benefits!  I realized this after the birth of my first child, which was an induction that lead to cesarean.  I was induced before my body was ready, laid flat on my back with an epidural for 15 hours, which lead to a mal-positioned baby resulting in the need for a Cesarean.  I went on to have two VBACs where I was not induced, was upright and active, and had great deliveries. 


So what are all of the benefits? 

Shorter Labors
As I just mentioned from my own experience, when mom is upright and actively working through her labor, labor tends to be shorter.  There are several cardinal movements of birth where the baby has to actively rotate and descend through the pelvis during labor and birth.  Being upright and able to change positions frequently during labor facilitates this process and helps prevent the baby from getting stuck in a bad position.  Getting an epidural or other pain medications limits mobility, and may slow labor contractions.  

Faster Recovery Time
Women who have natural birth usually feel great a short while after delivering their babies.  They are able to be upright shortly after labor if they desire, and they can walk around or take a shower.  After natural childbirth mothers usually experience a euphoria caused by the release of endorphins in the body during labor. As I will discuss below, tests have shown that a woman’s body will not release nearly as many endorphins if a pain medication is utilized.

Empowering Experience
While there is no medal given for giving birth naturally, it is an empowering and life-changing experience.  Similar to running a marathon or any other physically and emotionally draining process, women feel a strong sense of achievement and confidence that helps them through motherhood. 

Alert Experience
When narcotics are not used during labor, women are very alert and fully conscious of the experience. This allows them to be fully present when their babies arrive, and be connected to their bodies in a profound way.
 
Experiencing the Hormonal Cocktail of Birth
To understand the benefits of natural childbirth, we need to understand the complex hormonal changes that take place during labor and birth which involves the following hormones: estrogen, progesterone, oxytocin, beta-endorphins, prolactin and catecholamines.  Estrogen and progesterone play a crucial role in the initiation of labor to prepare the uterus for contractions in labor.  Oxytocin is associated with the contractions of labor, and has also been referred to as the hormone of love because of its involvement with sexual activity, orgasm, birth and breastfeeding. Oxytocin is released as labor begins, and increases in amounts as labor progresses.  After birth, when the infant stimulates the mother’s breast, high levels of oxytocin are produced to contract the uterus and prevent postpartum hemorrhage.  Oxytocin also facilitates the “milk ejection reflex” which allows for successful breastfeeding. And finally, oxytocin promotes a strong bond between mother and baby as the hormone of love flows in high amounts.  Beta-endorphin is a naturally occurring opiate that helps mothers deal with the pain of childbirth.  High amounts are produced in labor, allowing the mother to enter into a trance-like state going deep into herself, or ‘laborland’.  Prolactin is released by the pituitary during pregnancy and lactation, which prepares the woman’s breasts for lactation.  The combination of prolactin and oxytocin contribute to the elevated mood and calm feeling mothers experience during breastfeeding.  Catecholamines are the “fight or flight” hormones which peak right before transition (the hardest part of labor).  These high levels stimulate uterine contractions, contributing to the “Fetus Ejection Reflex” which occurs as baby is born. 

So what happens when we add interventions like an epidural, narcotics, or synthetic oxytocin (Pitocin) to the hormonal cocktail of labor?  Unfortunately, all of these medications have a significant impact on the production of these hormones in labor.  Whenever an epidural is given and all pain is removed this inhibits beta-endorphin production, which is the hormone that helps moms reach the altered shift in consciousness in dealing with the intensity of labor.  Following this, naturally occurring oxytocin levels drop, which can cause labor contractions to slow down.  Without high levels of oxytocin and beta-endorphins, a surge in catecholamines does not occur as the birth becomes imminent. 

Synthetic oxytocin (Pitocin) can also interfere with the delicate orchestration of hormones during
birth.  The effect of synthetic oxytocin is not the same as that of natural oxytocin produced by a laboring woman.  When Pitocin is given, it does not cross the blood/brain barrier unlike naturally occurring oxytocin.  As a result, the pituitary is not stimulated to release beta-endorphins. Without the pain-relieving help of abundant beta-endorphins, women who are induced with Pitocin are more likely to require epidurals. The uterine contractions produced by synthetic oxytocin are longer, more forceful and much closer together than a woman’s natural contractions since IV Pitocin is delivered continuously and natural oxytocin is delivered in spurts as the body needs it. This can cause significant stress to the baby, because there’s not enough time to recover from the reduced blood flow that happens when the placenta is compressed with each contraction. The net effect of this is to deprive the baby of necessary supplies of blood and oxygen, which can in turn lead to abnormal fetal heart rate patterns and fetal distress.


A Swedish study showed there is nearly 3 times greater risk of asphyxia (oxygen deprivation) for babies born after augmentation with Pitocin. And a study in Nepal showed that induced babies were 5 times more likely to have signs of brain damage at birth.

Pitocin can also cause complications for birthing women. Evidence suggests that women who receive Pitocin have increased risk of postpartum hemorrhage, which is likely due to the prolonged exposure to synthetic oxytocin.  Continuously administering Pitocin through an IV makes the oxytocin receptors in her uterus insensitive to oxytocin and her own postpartum oxytocin release ineffective in preventing hemorrhage after birth.


As you can see, the introduction of interventions like epidurals and Pitocin disrupts the hormonal orchestration of labor, which results in women giving birth with relatively low levels of naturally occurring oxytocin, endorphins, and catecholamines.  These are powerful hormones of love and ecstasy which produce euphoric feelings in a mother who has just given birth and facilitates bonding between mother and baby.


Epidurals May Lead to Other Interventions
Once an epidural is added, a mother will be connected to several wires or lines prohibiting mobility including the following:  epidural line in her back, IV line in one arm, blood pressure cuff on the other arm, pulse oximeter on finger, two belts around her waist for continuous monitoring of contractions and the baby, a catheter for urine, and sometimes fetal monitor attached to the infant's scalp. 
 
Epidurals have been shown to have the following effects on labor, laboring mothers, and the baby:
  • May cause sudden drop in blood pressure.
  • May experience a severe headache caused by leakage of spinal fluid (1% of women experience this side effect). A procedure called a “blood patch”, which is an injection of your blood into the epidural space, can be performed to relieve the headache.
  • Epidurals require continuous monitoring for changes in fetal heart rate.
  • Other side effects include shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating.
  • May make pushing more difficult and additional medications or interventions may be needed such as forceps, vacuum, or Cesarean.
    • Is triple the occurrence of induction with Pitocin.
    • Increases the risk of cesarean section by 2.5 times.
  • Numbness for a few hours after the birth in the lower half of your body.
  • In rare instances, permanent nerve damage may result in the area where the catheter was inserted.
  • Epidural medication does reach the baby.  Most studies suggest that some babies will have trouble “latching on”, causing breastfeeding difficulties. Other studies suggest that a baby might experience respiratory depression, fetal mal-positioning, and an increase in fetal heart rate variability, thus increasing the need for forceps, vacuum, cesarean deliveries and episiotomies.
  • May lengthen labor.
  • Increase the chance of fever, which increases the likelihood antibiotics will be prescribed.
  • Triples the risk of severe perineal tear.  Since the mother is numb, she may push harder than needed, whereas a mother without an epidural is in-tune with pushing, listening to her body.
  • Quadruples the chance that a baby will be persistently posterior (face up) in the final stages of labor, which in turn decreases the chances of spontaneous vaginal birth.
  • Increase the chance of complications from instrumental delivery. When women with an epidural had a forceps delivery, the amount of force used by the clinician was almost double that used when an epidural was not in place. Instrumental deliveries can increase the short-term risks of bruising, facial injuries, displacement of skull bones and blood clots in the scalp for babies, and of episiotomy and tears to the vagina and perineum in mothers.
  • Increase the risk of pelvic floor problems (urinary, anal and sexual disorders) in mothers after birth.

Other Risks Associated with Pitocin
The U.S. Pitocin package insert includes the following warning of issues that it can cause:
  • fetal heart abnormalities (slow heartbeat, PVCs and arrhythmias)
  • low APGAR scores
  • neonatal jaundice
  • neonatal retinal hemorrhage
  • permanent central nervous system or brain damage
  • fetal death
Pitocin during labor may also lead to the following:
  • Tumultuous labor and tetanic contractions, which may cause:
    • premature separation of the placenta
    • rupture of the uterus
    • laceration of the cervix
    • postbirth hemorrhage.
  • Fetal hazards include: fetal asphyxia and neonatal hypoxia from too frequent and prolonged uterine contractions, physical injury and prematurity if the due date is not accurate.

I Want to Plan a Natural Childbirth, So What Now?
If a mother decides that she would like to experience a natural childbirth, a mother can plan a natural childbirth at home, birth center, or hospital.  Choosing the right care team can make a big difference.  Ask around to find the right care team.  Doulas are a great resource and can tell you about different options in your area.  You can also ask on natural childbirth or other natural support groups or Facebook groups.  However, as mentioned before, birth is a mystery, and flexibility is needed when things do not go as planned and interventions are needed.  Don’t beat yourself up if your birth doesn’t go as plan.  Do take time to grieve and get support. 

I Want a Natural Childbirth but I’m Scared of the Pain!

A great resource for overcoming fear in childbirth is the classic Childbirth without Fear by Dick-Read.  Our bodies are designed to give birth facilitated by a magical cocktail of hormones to help us through the process.  Plan ahead for your natural childbirth experience by educating yourself on the process.  Ways to prepare:
  • Childbirth Education Classes – there are several different kinds of childbirth educations classes you can take.  Look into different ones and see what is a good fit for you and your partner.  Some great ones include:
    • The Bradley Method
    • Hypnobabies
    • International Childbirth Education Association Instructors
    • Birth from Within
  • Hire a doula – Fabulous resource to help you and your partner through the process.
  • Read books!  Some of my favorites include:
    • The Birth Partner
    • Ina May’s Guide to Childbirth
    • Active Birth
    • Natural Birth the Bradley Way
    • The Birth Book by Sears
    • Childbirth without Fear
  • Trust your body.
  • Listen to positive affirmations.
  • Eat well – Nutrition plays an important role in keeping mothers low risk to avoid certain interventions.
  • RELAX! Birth is easier when we don’t fight it, but go with it.  Practice relaxation techniques.
 
By Shannon Greika, Certified Professional Midwife

 
References
Buckley, S. (2015). Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies,
and Maternity Care. Childbirth Connection Programs, National Partnership for Women & Families.
 
Buckley, S. (2009). Gentle birth, gentle mothering: a doctor’s guide to natural childbirth and early
parenting choices. Celestial Arts.
 
Dick-Read, G., Snaith, L., & Coxon, A. (1968). Childbirth without fear: The principles and practice of
natural childbirth. London: Heinemann
 
Lothian, J.
(2005).  The Birth of a Breastfeeding Baby and Mother.  J Perinat Educ. 2005 Winter; 14(1):
42–45. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595228/
 
Milsom, L., Ladfors, L., Thiringer, K., Niklasson, A., Odeback, A., & Thornberg, E. (2002).  Influence of
maternal, obstetric and fetal risk factors on the prevalence of birth asphyxia at term in a Swedish urban population.  Acta Obstet Gynecol Scand. 2002 Oct;81(10):909-17. http://www.ncbi.nlm.nih.gov/pubmed/12366480
 
Matthew, E., Manandhar, N., Manandhar, D., & Costello, A. (2000). Risk factors for neonatal
encephalopathy in Kathmandu, Nepal, a developing country: unmatched case-control study.  BMJ. 2000 May 6; 320(7244): 1229–1236. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC27363/
 
Odent M. The scientification of love. Free Association Books 1999.
 
http://americanpregnancy.org/labor-and-birth/epidural/

http://naturallysavvy.com/nest/the-benefits-of-natural-childbirth
1 Comment

What is the Midwifery Model of Care Like? 

9/24/2015

1 Comment

 
Women have been helping other women have babies since the beginning of time.  However, in the United States, dramatic changes have occurred over the last century regarding midwifery where it was nearly eradicated.  In spite of this, midwifery has made a reemergence over the last 40 years.  According to Davis (2004), “Midwifery is alive today for one reason only: women’s insistence on midwifery care” (p. 2).  The Midwives Model of Care (MMC) is dramatically different from the Medical Model of Care, which is currently the care most pregnant women receive in the United States.   The principles of the MMC are as follows (Citizens for Midwifery - Midwifery Task Force, Inc., 1996):

  1. Monitoring the physical, psychological, and social well-being of the mother throughout the      childbearing cycle.
  2. Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support.
  3. Minimizing technological interventions.
  4. Identify and referring women who require obstetrical attention.  

One of the most basic principles of the MMC is the focus on the mother as a whole; including the physical, psychological, and social well-being; and individualized care.  A typical prenatal exam with a midwife is much longer than a typical prenatal exam with an obstetrician, lasting up to an hour verses less than 10 minutes.  During these longer prenatal exams, the midwife develops a close relationship with the mother, and is able to assess not only the mother’s physical well being, but psychological and social well-being as well.  This is extremely important as much is to be learned during this time that plays a significant role in the pregnancy, labor, and delivery of the baby.  For instance, fears, which could potentially impact the mothers’ pregnancy and/or labor, can be addressed.    Also, any social issues, such as issues with the mother’s partner, family, work, etc. that may be affecting her stress levels, can be discussed.  The psychological and social well-being of the mother has a direct impact on the physical well-being of the mother, which significantly impacts the health of the pregnancy and the baby.   Each mother’s pregnancy is treated as a unique situation where education, counseling, care, and support can be tailored specifically to meet that mother’s needs.  For instance, a thorough discussion on nutrition, which significantly impacts the health of the pregnancy, can be made where the mother is educated and encouraged on wise choices.  

In the Medical Model of Care, the treatment of the pregnant women can be very standardized.  Birth in the U.S. has become overly industrialized with large obstetrical practices with as many as eight or nine rotating physicians seeing mothers during their pregnancy making it hard to develop a strong relationship and trust with a caregiver. In addition, in the hospital setting, it is difficult to get individualized care as hospitals must follow strict hospital protocols.

The MMC is also different during labor and delivery where the mother is given continuous hands-on assistance with a caregiver whom she has had the opportunity to form a deep and trusting relationship with, instead of an unfamiliar nurse, who is in and out of the room, and will be different upon shift change.   Enkin et al. (2000) mentions a Canadian study that found that women giving birth in a hospital encountered an average of six unfamiliar professionals during labor, with some women reporting up to 14 attendants (p. 249).  Additionally, several studies have shown that on average less than 10% of the labor nurse’s time was spent in supportive activities (Enkin et al., 2000, p. 249).  In addition, during midwifery care women are also encouraged to move around during labor, eat and drink, and to push in whatever position the woman chooses. 

Another hallmark of the MMC is minimal technological interventions.  Midwives believe that childbirth is a natural physiological process that is typically safest when left alone.  Just as a cat or any other mammal seeks a dark, quiet, and safe place to birth; human birth thrives under those same conditions.  Imagine a cat trying to give birth in a bright hospital room, lying in bed strapped to monitors and an IV, with strangers in and out of the room, and several people yelling at the cat to “push”.    Midwives respect the sacredness of birth and work to protect the birth space, only intervening when truly necessary.  Midwives understand that many of the interventions that are routinely performed in the hospital contribute to many complications for mothers and babies by not allowing the natural process of birth to take place.  Even after the birth, the many routine interventions done immediately at births in the hospital interfere with the critical bonding time between mothers and babies, contributing to breastfeeding issues.  Midwives understand that mother and baby should be treated as a whole where they are inseparable and interdependent (MANA Statement of Ethics, 1992). 

Research by Johnson and Daviss (2005) shows rates of medical interventions were much lower for planned homebirths attended by Certified Professional Midwives (CPM) than for low risk hospital births.  The same study showed that CPM attended planned homebirths had comparable mortality rates during labor and delivery, similar to rates found in most studies of low risk hospital births in North America.  Additionally, a higher degree of maternal satisfaction was reported.  A review of 21 studies comparing births attended by certified nurse midwives and physicians found no difference in infant outcomes between the 2 groups, and less use of interventions such as labor induction, episiotomy, and epidurals by the nurse midwives (Johantgen, et al., 2011).  Midwives also have much lower cesarean rates, 3-4% for out of hospital midwives compared to 32.8% for national average (Citizens for Midwifery, 2006) and (CDC, 2011).  This dramatic difference in cesarean births has significant impact on outcomes for mothers and babies as maternal and neonatal mortality is tripled for cesarean births (Deneux-Tharaux, et al., 2006) and (MacDorman, et al., 2006).

Postpartum care during the MMC is much more in-depth and individualized as well.  Typically, with a homebirth midwife, there are four postpartum visits as follows:  one to two days, one week, three weeks, and six weeks.  While under the Medical Model of Care, you typically see the obstetrician upon hospital discharge and do not see the obstetrician again until six weeks postpartum.  The baby will see the pediatrician, but the mother is not giving as much follow-up during this critical time.     

The final principle of the MMC is identifying and referring women who require obstetrical attention.  Midwives are experts in normal pregnancy and birth, and have been trained to recognize when birth is deviating away from normal.  Home birth has been proven to be safe for low risk births.  Therefore, if issues arise where the mother is no longer considered low risk, these issues must be discussed and obstetrical care sought.  Midwives incorporate intuition along with clinical knowledge.  In addition, midwives develop a deep knowledge of each individual client during long prenatal appointments which assist midwives in recognizing issues that may be arising.  Additionally, to keep home birth safe, midwives must work to develop relationships with consulting practitioners and hospitals.  It is also important for midwives to develop and follow practice guidelines.

Because of the holistic, individualized, hands-on care that midwives provide, the MMC provides great outcomes for mothers and babies.  Midwives attend 70 percent of all births in the six countries with the lowest perinatal mortality rates in the world (Davis, 2004, p.1).  In the United States, where midwives attend only 5 percent of births, perinatal mortality is much higher, ranking twenty-sixth worldwide (Davis, 2004, p.1).   According to the World Health Organization (WHO), the United States is currently ranked 41st in maternal mortality (2008).  The likelihood of a woman dying in childbirth in the U.S. is five times greater than in Greece (WHO, 2008).  Not only is the perinatal and maternal mortality rates worse in the United States than most other developed nations, but the cost of healthcare is much higher (Wagner, 2006, p. 243).  Physicians are trained surgeons who are more expensive and their skills do not need to be utilized for most low risk births.  Additionally, the cost of many of these unnecessary routine interventions and cesareans are contributing to the high cost of healthcare in this country.  Increasing the number of midwife attended births in the United States would not only provide safe births with less interventions and better outcomes for mothers and babies, but also lower the cost of healthcare, and result in higher levels of satisfaction with the birth experience. 

By Shannon Greika, CPM
​
References

Citizens for Midwifery:  Midwifery Task Force.  (1996). Midwives model of care.  Retrieved       from http://cfmidwifery.org/mmoc/define.aspx


Citizen for Midwifery. (2006). Out-of-hospital midwifery care: Much lower rates of cesarean       sections for low-risk women.  Retrieved from       http://www.cfmidwifery.org/pdf/cesarean2x.pdf

Davis, E. (2004). Heart & hands: A midwife’s guide to pregnancy and birth.  New York, NY:                    
Celestial Arts.

Deneux-Tharaux, C., Carmona, E., Bouvier-Colle, M.H., & Breart, G. (2006). Postpartum  maternal mortality and cesarean delivery.  Obstetrical Gynecology, 108(3 Pt 1), 541-8.         Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16946213

Enkin, M. W., Keirse, M. J., Neilson, J. P., Crowther, C. A., Duley, L., Hodnett, E. D., &  Hofmeyr, G. J. (2000). A guide to effective care in pregnancy and childbirth. New York, NY: Oxford University Press

Hamilton, B. E., Martin, J. A, & Ventura, S. J. (2010).  Births:  Preliminary data for 2010. Center   for Disease Control: National Vital Statistics Reports. 60(2).

Johantgen, M., Fountain, L., Zangaro, G., Newhouse, R., Stanik-Hutt, J., & White, K. (2012).      Comparison of labor and delivery care provided by certified nurse-midwives and   physicians: a systematic review, 1990 to 2008.  Womens Health Issues. 22(1), 73-81.   Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21865056

Johnson, K. C., & Daviss, B. A. (2005).  Outcomes of planned home births with certified professional midwives: large prospective study in North America.  BMJ, 330, 1416.
 doi: 10.1136/bmj.330.7505.1416

MacDorman, M. F., Declercq, E., Menacker, F., & Malloy, M. H. (2006). Infant and neonatal       mortality for primary cesarean and vaginal births to women with "no indicated risk,"       United States, 1998-2001 birth cohorts.  Birth. 33(2), 175-82.  Retrieved from
http://128.193.4.112/cla/anthropology/reproductive_lab/sites/default/files/MacDorman_2   006.pdf


Midwives of North America. (1992). Statement of values and ethics.  Retrieved from:             http://mana.org/valuesethics.html

Wagner, M. (2006). Born in the USA: How a broken maternity system must be fixed to put             women and children first. Berkley, CA: University of California Press.

World Health Organization.  (2008).   Maternal Mortality Ratio [Data file].  Retrieved from                           
http://apps.who.int/ghodata/

1 Comment

Safety of Home Birth 

3/10/2015

2 Comments

 
The safety of home birth has been a long debated topic.  Because of the controversy, the safety of home birth has been studied extensively.   The midwives’ model of care contributes to the safety of homebirth, which includes continuity of care and less intervention.   Outcomes of planned home births with qualified midwives are comparable or better than outcomes of hospital births, and have lower rates of medical interventions.

U.S. Studies
Several studies regarding the safety of home birth have taken place over the last 30 years in the United States.  Early studies regarding home birth in the United States were performed by Mehl (1977 and 1978).  The 1977 Mehl study gives data showing the safety of home birth attended by direct-entry midwives following 1,146 cases.  The 1978 Mehl study shows better outcomes for planned home births compared to planned hospital births following 2,092 matched pairs.  Several others studies were performed in the United States showing the safety of direct-entry ‘lay’ midwives in North Carolina (Burnett, Jones, Rooks, Tyler, & Miller, 1980), Arizona (Weitz, R., & Sullivan, D. (1984). Weitz, R.,& Sullivan, D. (1984).Weitz & Sullivan, 1984), Kentucky (Hinds, Bergeisen, & Allen, 1985), the Farm in Tennessee (Durand, 1992), and Washington State (Janssen, Holt, & Myers, 1994).

One of the larger home birth study that is frequently sited was performed by Johnson and Daviss (2005) covering 5,000 home births attended mostly Certified Professional Midwives (CPMs) in the United States and showed that CPM attended planned home births had comparable mortality rates during labor and delivery to rates found in most studies of low risk hospital births.  A conflicting study was issued in American Journal of Obstetrics & Gynecology (AJOG), (Wax et al., 2010) showing a higher neonatal mortality rate for planned home births verses hospital births.  However, many have since determined that the design of the study was flawed for several reasons, one reason being that it included unplanned and planned home births (Michel, Janssen, Vedam, Hutton, & de Jonge, 2011).  

The most recent study is the largest analysis of planned home birth in the U.S. ever published which examines nearly 17,000 courses of midwife-led care (Cheyney et al., 2014).  This study was issued in peer-reviewed Journal of Midwifery & Women’s Health, and confirms that among low-risk women, planned home births result in low rates of interventions without an increase in adverse outcomes for mothers and babies.


Studies Around the World
Study after study performed all over the world  have also shown home birth outcomes to be comparable or better than hospital outcomes in terms of perinatal and maternal mortality, with substantially less interventions.  
The largest study to date looked at more than 500,000 births to healthy women in the Netherlands and found perinatal mortality to be similar between planned home birth and planned hospital birth (de Jonge et al., 2009).  In Canada, a 2009 study showed that planned home births attended by a registered midwife resulted in low and similar rates of perinatal death, less intervention and less other adverse outcomes compared with planned hospital birth attended by a midwife or physician (Janssen et al., 2009).

Factors Contributing to Home Birth Safety
Several factors contribute to the safety of home birth, such as continuity of care, individualized care, less intervention, well screened clientele, and more in-depth postpartum care.  Being in the mother’s own home exposes her to less risk of infection by being around familiar germs.  Additionally, the mother is more comfortable in a familiar environment which is supportive of physiological birth.   
           
Women who birth at home with a midwife receive continuity of care where they are supported throughout their entire pregnancy with a caregiver whom she has had the opportunity to form a deep and trusting relationship.  During labor and delivery, the mother is given continuous hands-on assistance with this same caregiver.  This continuity of care allows for the midwife to see the ‘whole’ picture regarding this mother and her pregnancy, making it easier to identify when things might no longer be ‘normal’ for this particular mother. Large obstetrical practices may have as many as eight or nine rotating physicians seeing the mother during her pregnancy, which makes continuity of care impossible.  Continuity of care during hospital birth is further diminished when the laboring mother arrives at the hospital to be supported by a nurse they have never met, and will be given a new nurse as shifts change.  Enkin et al. (2000) mentions a Canadian study that found that women giving birth in a hospital encountered an average of six unfamiliar professionals during labor, with some women reporting up to 14 attendants (p. 249).  Additionally, several studies have shown that on average less than 10% of the labor nurse’s time was spent in supportive activities (Enkin et al., 2000, p. 249).

 Another factor contributing to the safety of home birth is the holistic and individualized care the mother receives.  Midwives focus on the mother as a whole; including the physical, psychological, and social well-being.  A typical prenatal exam with a midwife may be 45 minutes to an hour long.  During these longer prenatal exams, the midwife develops a close relationship with the mother, and is able to assess not only the mother’s physical well being, but psychological and social well-being as well.  This is extremely important as the psychological and social well being of the mother has a direct impact on the physical well being of the mother, which significantly impacts the health of the pregnancy and the baby.   This intimate relationship that is formed contributes to the overall safety of the birth, as the midwife is given more opportunities to identify potential issues or red flags that may need to be discussed or addressed.  It also gives the midwife more opportunity to rely on her intuition regarding a situation.  These longer prenatal appointments foster the opportunity to develop individualized care.  Each mother’s pregnancy is treated as a unique situation where education, counseling, care, and support can be tailored specifically to meet that mother’s needs.  For instance, a thorough discussion on nutrition, which significantly impacts the health of the pregnancy, can be made where the mother is educated and encouraged on wise choices. 

A significant factor contributing to the safety of home birth is the lower use of interventions.  Midwives believe that childbirth is a natural physiological process that is typically safest when left alone.  Just as a cat or any other mammal seeks a dark, quiet, and safe place to birth; human birth thrives under those same conditions.  A mother is more comfortable in her familiar environment at home which supports physiological birth.  Midwives understand that many of the interventions that are routinely performed in the hospital contribute to complications for mothers and babies by not allowing the natural process of birth to take place. 

Research by Johnson and Daviss (2005) shows rates of medical interventions were much lower for planned home births attended by CPMs than for low risk hospital births, and showed comparable mortality rates during labor and delivery.  Additionally, a higher degree of maternal satisfaction was reported.  Midwives also have much lower cesarean rates, 3-4% for out of hospital midwives compared to 32.8% for national average (Citizens for Midwifery, 2006) and (CDC, 2011).  This dramatic difference in cesarean births has significant impact on outcomes for mothers and babies as maternal and neonatal mortality is tripled for cesarean births (Deneux-Tharaux, et al., 2006) and (MacDorman, et al., 2006).

Because of the medically minded nature of the culture in the United States, along with the fear of birth from media portrayal, many erroneously assume that home birth is not safe.  However, research from the United States and all over the world show tha
t outcomes of planned home births with qualified midwives are comparable or better than outcomes of hospital births. 

Increasing the number of midwife attended home births in the United States would provide safe birth options with less interventions and better outcomes for mothers and babies.

By Shannon Greika, CPM
​
References

Burnett, C., Jones, J., Rooks, J., Tyler, C., & Miller, A.  (1980).  Home delivery and neonatal mortality in North Carolina.  Journal of American Medical Association, 244(24), 2742- 2745.

Citizen for Midwifery. (2006). Out-of-hospital midwifery care: Much lower rates of cesarean sections for low-risk women.  Retrieved from http://www.cfmidwifery.org/pdf/cesarean2x.pdf

Cheyney, M., Bovbjerg, M., Everson, C., Gordon, W., Hannibal, D., & Vedam, S. (2014).  Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009.  Journal of Midwifery & Women's Health. Vol 59(1). pp. 17-27.

de Jonge, A., van der Goes, B.Y.,  Ravelli, A. C., Amelink-Verburg, M. P., Mol, B. W., Nijhuis,  
J. G., Bennebroek Gravenhorst, J., & Buitendijk, S. E. (2009). Perinatal mortality and
morbidity in a nationwide cohort of 529,688 low- risk planned home and hospital births.
BJOG, 116(9), 1177-84. doi: 10.1111/j.1471-0528.2009.02175.x

Deneux-Tharaux, C., Carmona, E., Bouvier-Colle, M.H., & Breart, G. (2006). Postpartum maternal mortality and cesarean delivery.  Obstetrical Gynecology, 108(3 Pt 1), 541-8.   Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16946213

Durand, M. (1992). The safety of homebirth: The farm study. Journal of American Public Health Association, 82, 450-452.

Enkin, M. W., Keirse, M. J., Neilson, J. P., Crowther, C. A., Duley, L., Hodnett, E. D., &                         
Hofmeyr, G. J. (2000). A guide to effective care in pregnancy and childbirth. New York, NY:  Oxford University Press

Hamilton, B. E., Martin, J. A, & Ventura, S. J. (2010).  Births:  Preliminary data for 2010. Center for Disease Control: National Vital Statistics Reports. 60(2).

Hinds, M., Bergeisen, G., & Allen, D. (1985).  Neonatal outcomes of planned vs. unplanned out- of-hospital births in Kentucky.  Journal of America Medical Association, 253(11), 1578- 1582.

Janssen, P. A., Holt, V. L., & Myers, S. J. (1994). Licensed midwife-attended, out-of-hospital births in Washington state: are they safe? Birth, 21(3), 141-8.

Janssen, P.A., Saxell, L., Page, L. A., Klein, M. C., Liston, R. M., & Lee, S. K. (2009). Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. CMAJ, 181(9), 617.

Johnson, K. C., & Daviss, B. A. (2005).  Outcomes of planned home births with certified professional midwives: large prospective study in North America.  BMJ, 330, 1416.
doi: 10.1136/bmj.330.7505.1416

MacDorman, M. F., Declercq, E., Menacker, F., & Malloy, M. H. (2006). Infant and neonatal mortality for primary cesarean and vaginal births to women with "no indicated risk," United States, 1998-2001 birth cohorts.  Birth. 33(2), 175-82.  Retrieved from 
http://128.193.4.112/cla/anthropology/reproductive_lab/sites/default/files/MacDorman_2 006.pdf 

Mehl, L. (1977). Outcomes of elective home births:  A series of 1146 cases.  Journal of Reproductive Medicine, 19, 281-290.  

Mehl, L. (1978). Scientific research on childbirth alternatives & what it tells us about hospital practice.  21st Century Obstetrics, 1, 171-207.  

Michal, C. A., Janssen, P. A., Vedam, S., Hutton, E. K., & de Jonge, A. (April 1, 2011). Planned home vs. hospital birth: A meta-analysis gone wrong. Medscape Ob/Gyn. Retrived from http://www.medscape.com/viewarticle/739987

Wagner, M. (2006). Born in the USA: How a broken maternity system must be fixed to put women and children first. Berkley, CA: University of California Press.

Wax, J. R., Lucas, F. L., Lamont, M., Pinette, M. G., Cartin, A., & Blackstone, J. (2010).   Maternal and newborn outcomes in planned home birth vs. planned hospital births: a metaanalysis. American Journal of Obstetrics & Gynecology. 203(3), 243.

Weitz, R., & Sullivan, D. (1984). Licensed lay midwives in Arizona. Journal of Nurse- Midwifery, 29(1), 21-28.

World Health Organization.  (2008).   Maternal Mortality Ratio [Data file].  Retrieved from                            
http://apps.who.int/ghodata/


2 Comments

    Author

    Shannon Greika, CPM

    Archives

    October 2016
    August 2016
    November 2015
    September 2015
    March 2015

    Categories

    All

    RSS Feed

Powered by Create your own unique website with customizable templates.