Saturday, September 13, 2008

From OBGYN to Midwife

When I was researching midwives, I came across some numbers that I'd like to share. Forgive me, for I don't remember my source, but I remember very clearly what it said: At a typical office visit with an OBGYN, he/she will give you five minutes. If your appointment is with a Certified Nurse-Midwife (CNM), usually practicing in a hospital group, appointments will last on average 15 minutes. If you are meeting with a Certified Professional Midwife (CPM) or a Licensed Midwife (LM), practicing usually at a free-standing birth center or homebirth, you can expect your appointments to last about an hour. In my experience, this has absolutely been true.

The midwife typically considers the entire woman and her family, not just the vaginal opening, when it comes to labor and birth. Birth is affected by so many factors. A midwife who has spent, literally, hours with her client, knows her and her concerns very well. She is able to work with the laboring woman and help her because she knows her and her desires. A doctor is focused on getting the baby out. The focus is on the cervix, not the whole person.

Our Licensed Midwife with our third baby said to me, and I quote her often, "Birth is 90% in your head, and 10% what happens to you." I believe this.

I had a miscarriage between our first and second children. It was very early on in the pregnancy. I went in to talk to the OBGYN, Dr. Brian Wolsey, that we had used with the first baby, I guess to be sure that everything was fine. While I was there, I asked him if I chose to give birth in a different position with the next baby, would he support me? He got down on one knee, contorting his body with his hands in the air, up around his head, and said, "Well, it's kind of hard to catch a baby like this." I knew immediately that he didn't care for my question.

Let's let that sink in for a moment. Read his answer to yourself again.

This is where I take issue with the term, "delivered." A woman does not need to be "delivered." I saw this picture recently where the doctor is holding a baby in the foreground, all proud, that he "delivered" this baby to the mother. She was sitting in the hospital bed, smiling at the doctor, like she couldn't have done it without him. Maybe I read more into that than the average person, but I was so offended. Who is the hero here?

The professional a woman chooses to have at her birth should be "attending" her birth, not "delivering" her. Dr. Wolsey, by making that comment, made it all about him. I would be the one giving birth. I always teach that the laboring woman should follow her instincts. If her body needs to be upright (there's a number of reasons why you'd want to be in this position), then who is her doctor to tell her that she is inconveniencing him?!

Sitting there on that table, I remember watching him on the floor, dressed in his nice clothes and tie, and thinking, "What a jerk." How many c-sections has this guy given to women who could have given birth vaginally just fine? Remember, he told us at the end of my first pregnancy that my body had just reached a point where it didn't know what to do. My body grew the baby, but it doesn't know how to birth it? Am I going to be pregnant forever if you don't remove this baby from my body? I could have easily have had a c-section with this doctor. I was one of the lucky ones who did not.

There are thousands of doctors out there just like Dr. Wolsey. I knew at that moment, watching him on the floor, that I would never have an OBGYN attend any of my births again. I am lumping all doctors into one awful heap, but I am fairly comfortable with that at this point in the game. The c-section rate continues to rise all over the country, but in areas where there are a significant number of midwives attending births, the c-section rates are lower.

Take my home state of New Mexico -- they have one of the lowest c-section rates in the country, and about 1 in 3 births are attended by a midwife. This is not a coincidence. I in no way want to make NM sound like they have a low c-section rate, as they don't. It's too high everywhere. It's just lower than the majority of other states. The World Health Organization has stated that the c-section rate should be between about 10-15%. The US rate averages 1 in 3, or 33%, of American babies are born via c-section. Will we ever see it reverse? Frankly, it's become so accepted, it's hard to imagine the rate actually going down.

There are other contributing factors to the outrageous c-section rates -- decline in VBACs (vaginal birth after cesarean) inflicted by ACOG (American College of Obstetricians and Gynecologists) and malpractice suits, to name a few. And we can't forget the very ignorant women electing to have a c-section over a vaginal birth. This is a topic for another day, but I just wanted to address c-sections briefly as I "attack" the OBs.

1 comment:

Carmen said...

“You pay them (OBGYN) to work for you… “
What a concept! Why had I never viewed it that way? The day you said that to our class is the day that we decided to switch from our OB to our midwife. And even though our circumstances lead us to the hospital at just 35 weeks in labor I look forward to the day that we get to experience the relationship of a midwife from beginning to birth on our next munchkin!!!