Having a midwife attend your labor and birth increases the chance of having your baby naturally and without drugs!
In a prior blog, I wrote about how North Ottawa Community Hospital (NOCH) closed their midwifery practice in 2014. At that time, I contacted both federally qualified health centers (FQHCs) in Muskegon to ask them if they would be willing to have me interview them to help spread the word to expectant women in the area about their remaining options. Hackley Community Care (HCC) got back with me and we were able to videotape an interview with their collaborating physician, Dr. Danielle Koestner.
I have been at several births with the HCC midwives and have always been impressed by the way they respected and supported the wishes of my clients. The good relationship we had benefited our mutual clients because we were able to communicate concerns to better coordinate care.
When I learned that the HCC midwives were going to stop catching babies, my initial response was, “Not again!” Like others, I am still upset about losing the option of midwife-attended deliveries at NOCH. Still, I wanted to wait and find out more information. Earlier this week, I received the official letter from HCC, stating that the midwives were going to continue to provide pre- and post-natal care and that they were officially certified as a Centering Pregnancy site. Now, however, the obstetric laborist and residents at Mercy Health Hackley would be in charge of their pregnant patients’ labor and deliveries.
The laborist comes with a wealth of knowledge and experience. While many women include avoiding residents in their birth plans, I have found them to be on top of the latest research, open to patient preferences and supportive of evidence-based care. For some women, this will be an acceptable option. During their prenatal care, they will benefit from an evidence-based group prenatal care model, the individualized care characteristic of midwives and access to a host of other services offered on-site. However, for women specifically looking to benefit from the better outcomes research shows continuous care from a midwife during labor and delivery offers, this change will be unacceptable. The research shows that interventions are lower and outcomes improve when midwives provide care throughout the pregnancy, labor and delivery.
For women who seek a midwife to provide their prenatal care and attend their birth, Muskegon Family Care (MFC), Muskegon’s other FQHC with a midwifery program, recently hired new midwives and are now fully staffed. In July, I had the pleasure of meeting with one of them, Katie Van Heck, CNM, to discuss how to improve their services by increasing their patients’ access to doulas. I now have a couple of clients who are seeing the midwives there for care and I am excited to work more with this practice in the future!
If you live along the West Michigan lakeshore and you wish to deliver in a hospital, with a Certified Nurse Midwife (CNM), the only midwives who can practice in Michigan hospitals at this time, these are some of your remaining options:
- Muskegon Family Care – With three midwives on staff, this practice is located in a federally qualified health center in Muskegon Heights. This means they primarily serve low-income people, but they can serve anyone.
- Midwifery Services at Advanced Women’s Ob/Gyn – If Muskegon-area women are willing to travel to Spectrum Health Butterworth in Grand Rapids to deliver, this private midwifery practice has an 6% c-section rate, which speaks for itself.
What will be the next news for midwifery options along the lakeshore? Hopefully, something positive, like a new private practice or free-standing birth center opening up!
Did you have your baby with a midwife in a hospital? Please share your experiences in the comments!
Sandall, Jane, et al. “Midwife‐led continuity models versus other models of care for childbearing women.” The Cochrane Library (2016).
One of the things I loved about working for Public Health – Muskegon County was the opportunities for continuing education. Now that I’m self-employed, a smaller budget forces me to be more judicious while I also must work around being on-call. Nevertheless, 2016 is already turning out to be a great year for learning.
In January, I had the pleasure of attending the Michigan Affiliate of the American College of Nurse Midwives (ACNM) conference on physiologic birth in Kalamazoo. In April, I took a road trip with my kids and a friend to Alabama for the International Cesarean Awareness Network (ICAN) conference. Both of these provided chances to network and connect with people making a difference for birthing women in my state and across the country. Webinars are convenient, but nothing compares to getting to hang out in-person with inspiring individuals.
I would like to share some of what I learned from each of these trainings, to plant seeds of inspiration in expectant women and birth professionals everywhere. To do this, I’ll be sharing a series of blogs, highlighting the “pearls of wisdom” I learned from so many experts in the field of childbirth.
One of the speakers at the ACNM conference was Lisa Kane Low, PhD, CNM, FACNM, FAAN, who spoke on “Promoting Physiologic Birth to Reduce Primary Cesareans.” She introduced me to birthtools.org, an ACNM website that contains 3 quality improvement (QI) bundles for reducing primary cesareans: intermittent auscultation as a standard for low-risk women, comfort & coping and promoting spontaneous labor progress.
For those of you who aren’t familiar, Rebecca Dekker of Evidence Based Birth has a great article on what intermittent auscultation is, why it should be the standard of care for low-risk women and how to get it. Basically, intermittent auscultation is checking the baby’s heartbeat every so often through a fetal stethoscope, as opposed to through an electronic fetal monitor.
Listening to Dr. Kane Low speak, I couldn’t help but wonder about the mandatory “strip” in triage. For those who are unfamiliar, most hospitals put women who arrive in labor in an area called triage in which they are monitored to check on the baby’s health and the progress of labor. After a designated time period of being attached to an electronic fetal monitor, if the baby is responding well, the mother is either admitted or discharged home based upon how much she has progressed.
I have my own story to tell about triage. With my first baby, I had been laboring for about 22 ½ hours at home when I arrived in the hospital via the longest cab ride of my life. When I get to the maternity floor, they take their time, asking questions, entering information in the computer, pretty much ignoring the fact that I’m in labor. Finally, they assign me to triage. For the first time in my labor, I was confined to a bed, told to lie on my back, and had monitors strapped to me. Eventually, a nurse checked me and announced that I was completely effaced and dilated to an 8. Finally, they believed me that I was in labor! I couldn’t wait to get out of that room, off the bed, and get those uncomfortable monitors off of me!
So, I asked the presenter what evidence there is for this triage protocol. Her answer? “Data does not support the 20 min. strip in triage.” What?!? She went on to say that the only reason this remains standard practice is due to tradition.
Look, I understand that many women present to the hospital thinking that they are in labor, only to be sent home. However, for women like myself, arriving in active labor and being subjected to this practice that has no evidence to uphold a tradition? There is hope for change, though. The Alternative Birth Center at Providence Hospital in Southfield, MI, has ditched the 20 min. triage strips with great outcomes – way to go Providence!
In a typical interview with prospective clients, most doulas are asked about their philosophy on pregnancy & birth. This is a loaded question: parents are basically asking a complete stranger to succinctly tell them about their emotional, spiritual and political beliefs surrounding their life’s greatest passion. Considering how important it is to carefully choose who will be present throughout someone’s labor and birth, the question deserves an answer worthy of the honor, so here goes!
Although I am spiritual and open to mysteries I will never understand, I have faith in the scientific method. While sharing anecdotes is illustrative and healing, they should never solely replace the power of a double-blind randomized controlled trial. I want to teach and share what has been proven effective and safe.
Unfortunately, there are corporate interests that dictate what will be studied and published. Some holistic modalities are free, so the financial backing of studying their impact on birth outcomes is limited, but that is starting to change. Every day, I learn new research proving the positive impact of yoga, essential oils and other practices that are old to humans, but new to science. I want to embrace these new findings and incorporate them into my teachings and work.
The flip side of science is the ancient wisdom of women. If something works for an individual, they should continue that practice. When I was an office manager for holistic and alternative providers, I observed the most powerful impacts from those who believed the most strongly – our minds are powerful! Believe that true health is possible and it will be. Science may or may not catch up eventually.
What we know to be true can change. Take for example the Brewer Diet. Touted for years as the ultimate prevention for toxemia, research has never been able to replicate the studies of its creator. Since then, other dietary approaches have come forth that offer better results. I try not to become too emotionally attached to any health trend, because progress is not just inevitable, it’s desired.
Finally, there are choices. Science does not account for our individual needs. Someone may have other considerations than risk and health. Infant sleep is an example: some parents find the American Academy of Pediatric’s guidelines impossible to follow and are willing to bed-share for its other benefits, while trying to mitigate the risks. There is the best way, and then there is the most practical way for each family. Science and public health are focused on the collective, while families are all unique.
Trauma-informed implies context. Our personal experiences develop our intuition and beliefs that trump what is published in a peer-reviewed journal. Pregnancy and birth are a family’s journey that takes place within a mother’s body. To provide trauma informed care strips me of judgment and places me in a supportive role, whatever form that might take. I consider all women to be survivors of a misogynist culture and society. Those of us who choose to be mothers get to call the shots to emerge from pregnancy to motherhood an empowered being. A trauma-informed doula helps to ensure that the physical, emotional and medical encounters of pregnancy and birth be the result of enthusiastic consent by all involved parties.
Since the variations are endless, there is no way to prepare for every possibility of birth. Armed with good information, however, many negative possibilities can be averted. Focusing on prevention means that I want to spend more time advising a family of how to avoid a negative outcome than planning on how to respond should one occur. Little in life is unavoidable with proper planning and pregnancy is no exception. Seek support and information as early as possible.