Why We Chose a Midwife & Birthing Center

Being a healthcare practitioner, I often have people asking for my opinion or advice on a wide variety of topics ranging from “what should I eat” to “what do you think of vaccination.”  It comes with the territory, and I truly enjoy sharing my knowledge with people.

Then we decided to go through our pregnancy with a midwife and use a birthing center for delivery.

Open the floodgates.  I was now treading water in a sea of questions.

• What kind of training to midwives have?
• Is that safe?
• Wouldn’t a hospital be better?
• What if something happens?
• Can you get prenatal tests?
• Don’t you want the best for your wife?
• Aren’t they just labor coaches?
• What are you thinking?
• Ok, but who is your OB?
• Don’t you care for your wife?

You can see that they range from curious to malevolent.  And so this post was born to explain our decision and serve as a resource for future parents-to-be.

Midwife versus Hospital Birth

At the core of our decision was this: Casey and I have a philosophy that pregnancy is a naturally occurring healthy experience to be nurtured, and shouldn’t be treated as an illness or disease.  We did not come to that conclusion lightly, it took a lot of thought and fact finding, and it is one that I encourage all parents-to-be research and make on their own.

Here is what we learned through our discovery process.

Midwives and birth centers are for healthy, low risk mothers and healthy babies.  What constitutes low-risk?  Here is a list from our birth center:

I have certain health problems, so how do I know if out of hospital birth is safe for me?  Many women have health issues that are well controlled by lifestyle or medication and can still birth safely at the birth center. Examples are:

• Thyroid disorders managed with medication
• Mild asthma
• Depression managed with counseling or medication
• Abnormal pap smears, or surgery on the cervix
• Pregnancy with a prior history of infertility
• Women 35 or older
• History of miscarriage

The following is a partial list of common medical conditions that would “risk out” a woman from the birth center:

• Hypertension or high blood pressure
• Diabetes requiring insulin or medication
• Prior surgery on the uterus
• A new patient with a prior Cesarean birth planning on a vaginal birth with a subsequent pregnancy, or VBAC.
• At this time we can only offer VBAC’s to our established patients whose prior pregnancy under our care ended with a Cesarean birth
• Bleeding, or blood-clotting disorders
• With a first pregnancy, being very overweight with a BMI higher than 35
• With a second pregnancy or higher, being very overweight with a BMI higher than 40
• History of a blood clot
• Smoking more than 1 pack per day

The vast majority of women (80%) fall into the low-risk category and can have a normal birth.  The main benefit of using a midwife is that they are specialists in normal birthing.  Midwives focus more on women and babies, and less on technology.  Their thorough knowledge of normal birth allows them to safely minimize the use of technology and medical interventions during pregnancy and delivery.

Benefits of a Midwife Assisted Birth

• A personal, individual level of care than honors the woman’s body and birth plan.
• Lower intervention rates.  An episiotomy occurs in 80% of hospital births and midwives use it less than 1% of the time.  Labor is induced in 40% of hospital births and almost never in midwife-assisted birth.  Midwives also have lower rates of Cesarean, forceps and vacuum extractions, and infections.
• Midwives allow women to change positions, eat, and drink during labor.  They also allow labor to take the amount of time it needs.
• Midwives monitor the physical, psychological, and social well-being of the mother throughout the childbearing cycle (it’s typical to have monthly visits in trimester 1 and 2, and weekly in trimester 3).
• Midwives provide the mother with individualized education, counseling, prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support.
• Midwives DO identify and refer women who require obstetrical attention.
• Here is a great independent article on 8 Ways Midwives Promote Safe Childbirth

Research on Hospital Births

When you begin to research hospital births, what you find will shock you.  For all our technological advancements and incredible expenditures in modern medicine, our results are appalling.  About 99% of all births in the U.S. take place in hospitals, yet we currently rank 29th in the world in infant mortality.  This is the second worst newborn mortality rate in the developed world!  Who is in front of the U.S.?  Hungary, Northern Ireland, Australia, Israel, Japan, and 24 others (see full list here).

U.S. ranks 39th in deaths in childbirth

Even more important to me is the safety of my wife, Casey.  When examining the safety of women delivering babies in the Unites States, we find that maternal mortality is higher than 38 other industrialized countries, and is double that of Canada and much of Western Europe (remember, 99% of U.S. births take place in hospitals).

Extra Reading: U.S. urged to confront shocking maternal mortality rate – Amnesty International.

This is even more of a shock when you consider that Americans spend much more per person on health care than the rest of the world, with care for mothers and newborns combined being the fourth largest category of hospital expense!  That seems crazy.

Women from all cultures, tribes, and countries have been successfully having children without hospitals since time began.  Check this out:

In 1900, 95% of births in the United States took place at home.

In 1938, 50% of all births took place at home.

By 1955, less than 1% of births took place at home.

In 2008, midwives attended over 70% of births in Europe and Japan (remember those countries that did better than us in infant mortality rates?), but in the United States they only attended 7.5% of overall births.

Study: Comparing Equally Matched Midwife Attended Home-Births to Hospital Births

Women birthing in hospitals were:

• Five times more likely to have high blood pressure during labor
• Nine times more likely to tear
• Three times more likely to hemorrhage
• Three times more likely to undergo cesarean sections

Hospital-born babies were:

• Six times more likely to suffer fetal distress before birth
• Four times more likely to need assistance to start breathing
• Four times more likely to develop infections

Our Conclusion: hospital outcomes are simply not as good and involve much more risk for normal, healthy women than choosing a midwife.

What was your birthing experience?  Did you choose hospital, birthing center, or home with a midwife?  Any wisdom to share?  I’d love to hear your story, please share in the comments.