Obstetric Lie #82- You Should Hire An OB

Let's talk watermelon ladies.

I will date myself by admitting that I REMEMBER the advent of the horrid "seedless" watermelon.  I was a kid.  It seemed like a good idea at the time.  "Yeah," thought people, "Watermelon seeds are kind of a pain.  You have to spit them out.  Plus, my dad said if you swallow them, they grow in your stomach and out your ears.  Awful stuff."

And so, despite the pallid light pink color and the lack of flavor and juiciness, the seedless watermelon seemed to take over all watermelon sales in this country.  It happened so quickly that I don't even know if anybody really knew what happened.  One summer the seedless was introduced and by the next summer there was nary a seeded watermelon to be found.

We got used to it.  After all, even a seedless watermelon is still a watermelon and watermelons are yummy!

But some still remembered.....

The way a watermelon COULD be.  Juicy.  Red.  Dripping.  Tasty.  Crisp.  Huge.  The taste of summer.  Sure there were seeds, but they were so WORTH IT!

Last week I drove across town to a grocery store I don't usually go to and found- a giant seedED watermelon.  I took it home and cut it open.  My children had actually NEVER seen a black watermelon seed.

It was an incredible experience eating it.  Truth is, I will NEVER go back to the bland, yucky, pale, seedless watermelon.  The real thing is worth the drive and the effort.

Wait, isn't this a birth blog?

Yes it is.

Most women in the US hire an obstetrician (or OB) to be their care provider during the time of pregnancy and birth.  It is normal.  It is how "everybody" does it.  It is what insurance covers.  Of course the OB will tell you that you SHOULD hire an OB.  (Of course he would!  Always question the man with the money in his hand.)  It is "safer" to birth with an OB.  They know how to handle things if (WHEN) they go wrong.  This isn't the dark ages.  Be grateful for a doctor and use him.  

But ladies, this is a LIE.  

In fact actual studies have found that for a low risk woman, a midwife is a better option.  Really-  check this one out.  Wait there is ANOTHER study that found better outcomes with a nurse midwife!  Oh, and ANOTHER one!  There's just SO MANY!

What do these studies say about the difference between an OB and a midwife? 

This study found that,

"RESULTS:For measures that relate to the processes of care (e.g., epidural, labor induction, episiotomy), lower use was found for CNMs. For many of the infant outcomes (e.g., low Apgar, low birth weight, neonatal intensive care unit admission), there were no differences between physicians and CNMs. Perineal lacerations were lower and breastfeeding was higher among women cared for by CNMs compared with physicians."

 This one found that,

"Certified nurse-midwives were less likely to use continuous electronic fetal monitoring and had lower rates of labor induction or augmentation than physicians. Certified nurse-midwives also were less likely than physicians to use epidural anesthesia. The cesarean section rate for patients of certified nurse-midwives was 8.8% vs 13.6% for obstetricians and 15.1% for family physicians. Certified nurse-midwives used 12.2% fewer resources."

Basically, if you use a CNM (a Certified Nurse Midwife) in a  hospital you will have a baby that is as healthy but you will lower your chance of c-section, increase your chance of breastfeeding, lower your chance of perineal laceration (ouch), and increase your chance of an unmedicated birth.  

Frankly, that sounds pretty good to me.  Unless you WANT to have a lacerated perineum.

I do want to make a few things clear though.  These studies were done looking at CNMs or Certified Nurse Midwives.  These are generally registered nurses who have taken advanced training in midwifery.  They usually (but not always) work within a hospital (though some do run birth centers or do home births). 

There are ALL KINDS of midwives and their legality, availability and training vary from one state to the next. 

Here are a few things that are commonly misunderstood-

If you birth with a midwife you MUST birth at home-  This is NOT true.  Many midwives work only in the hospital.  This type of midwife (CNM) has medical training and often works within a hospital and with a physician.  Depending on what you desire this may be perfect for you or too restrictive.  There are different options for different women.
 
Midwives just have hot towels and sticks for use at a birth- What?!!  This is false.  Often home birth midwives are CPMs or Certified Professional Midwives.  (The certifications of a home birth midwife vary widely.  Check out your state and what is legal there.)  Though a CPM is not a CNM and their training and approach is sometimes different, some women prefer a CPM.  If you desire a home birth, a CPM is often who you will find to attend your birth.  As with any care provider, huge variations abound.             

I encourage every woman to find a midwife who is skilled, experienced, and who matches what other qualifications you desire.  I like an experienced midwife who has seen many births, but everybody is different.  My CPM brought oxygen, drugs and herbs for hemorrhage, an IV if needed, vast experience in suturing, equipment to monitor the baby, and much much more.  Even if you choose to birth at home with a CPM, that does not mean that sticks and hot towels are the extent of technology that she will posses.

(I won't get into the home VS hospital argument, it is a whole different ball of wax.  I covered it in THIS post and certainly got people riled up.  Oops!)

When it comes to care providers in the current birthing climate, I fear we have taken the same tasteless road as the seedless watermelon.  Many women don't even know that midwifery care is an option.  But it almost always is in some form in each community.

A few things that I have heard women say when they switch care providers from an OB to a midwife-

"She listened to me."

"She touched my stomach."

"She took time to answer my questions."

"I knew after my first visit that this was what prenatal care SHOULD be."

There are two stores in my town that have seeded watermelons.  One is across town.  The other charges an arm and a leg for them.  But once I REMEMBERED what a watermelon could taste like, I wouldn't go back.  Even though it took more work, even though it was different than what everybody else was doing, it was worth it.

We as a country have forgotten about midwives.  We have forgotten that our prenatal and birthing care doesn't have to feel like an assembly line.  We don't have to be stupid passengers who don't get a say in what happens to our own bodies.  We can have the perfect combination today of technology and touch.  That is what modern midwifery care CAN bring to a birth.

Take a look.  Try it out.  You just might be pleasantly surprised at what you find.

(And just because you know I need one....
Disclaimer-   Yes I realize that not ALL OBs are cruel, test running, task masters.  I am bold enough to admit though that I believe that MOST are.  The scientific literature backs up my opinion.  Yes, I also realize that not all midwives have the same philosophy.  Some are very medical.  Some even lack basic skills.  Some have no people skills.  Some just won't be what YOU want.  Picking a midwife doesn't mean you hand your choices over to somebody besides an OB.  Part of it means you TAKE RESPONSIBILITY for some of your care.  That is a big choice for many people and not everybody wants to make that choice.  That is fine, as long as you realize that it is your choice and what it entails.  Peace out. )