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Allowing the Decision to Choose a Midwife

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Message Carmen Stitt
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At 36 years old I became pregnant. I was in graduate school at the time with health insurance provided by my university. I remember crystal-clearly sitting in a chair with the doctor confirming what the home pregnancy test had already told me that, indeed, I was pregnant. Now, I had some new decisions to make.

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Where would I go for prenatal care? I had never given much thought to the details of medical care were I to become pregnant. There were a handful of medical practices covered in-network by my insurance, but there was also the option of using midwives through the local birth and women's health center. Any choice I made from one of those providers was covered under insurance. The decision was up to me.

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I immediately gravitated to the midwife option. I had read about water birthing in a local newspaper several years before. Tucson, a city of roughly 750,000, had a certified midwifery practice for the past 20 years and they offered prenatal care with the option of using whirlpool tubs in which to labor and deliver. I read the article with interest, thinking to myself that if women had to go through labor and relentless pain in giving birth, being immersed in a warm, jetted tub of water seemed the way to go about it. So I quickly signed up for prenatal care at the birth center.

Among my group of friends at the time were like-minded women who were educated, progressive, outspoken, and some of whom had experience with the birth center. Not knowing this before I become pregnant, as we shared our stories about pregnancies and where we were planning to deliver, it turned out some of them had delivered their babies at the birth center. This reassured me knowing that others had normal deliveries without complications and they lived to tell about it. All along the way, as easy as it was for me to make the decision to use midwives and a birthing center as my choice, there was always a chorus of voices in the back of my head doubting my decision.

I imagine that chorus is what most women take as fact. You deliver your babies in hospitals with doctors attending. That is the safest place. Doing anything different from that would be risky, even ludicrous. But there were other concerns for me.

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Instead, I was protesting the birth process in a hospital. Or what I thought was the birth process. My mother was a registered nurse for almost 50 years. She spent some of her early years working in hospitals and, consequently, she was exposed to the ways births happen in hospitals. She told me once in passing that doctors don't come in 'until the very end', that a woman is on her own to labor for as long as she labors and, when the time comes, the doctors essentially get in and get out to get the job done. Those were not her exact words, but that is what I took away from her observations. This felt very impersonal to me and I could not imagine a more personal experience in one's life than childbirth.

To back up my decision to use a midwife ex post facto, I began researching facts about midwifery. Initially, it was not easy to find information on the safety of midwife-attended births. This was before the internet provided any measure of information one could ever need at your fingertips. What I found is that midwifery outcomes were published extensively in Europe, where their use is much more common. In fact, in most European countries, midwifery is the standard of care for low-risk women. I also learned that one will not find midwifery outcomes in standard medical journals. Despite certified nurse midwives being part of the medical field, they do not publish in medical journals. Instead, they publish in their own journals. Once I directed my efforts toward midwifery and European medical journals, I found out staggering but, by my own account, pleasantly welcomed information. Women who used midwives had birthing outcomes the same if not better than those attended by doctors. The bottom-line for me was that there was overwhelming scientific evidence from numerous sources to support this claim.

When I told my mother that I would be using a midwife for prenatal care and delivery she was shocked, if not angered. "You're doing what?!" Although surely she had been made aware of certified nurse midwives, the practice of using them, let alone having them attend births, was not de rigueur in her experience. She asked questions about tests and procedures beyond which I had answers. "Would they be doing tests and screens just as you would normally do?" I too had a lot of questions swirling around in my head.

Throughout my pregnancy, I met all of what I think were five midwives at the birth center. I met each one in rotation as I progressed throughout routine check-ups. That way, the idea was that a woman would have at least met each midwife once by the time it was to deliver, and the midwife would not be an unfamiliar face. The birth center was situated on a major medical campus in town so it had the feel of being connected with a hospital even though it is classified as a stand-alone medical facility. In retrospect, that connection to a hospital buoyed any concerns I had about the safety of using a birth center instead of a hospital.

The birth center was formally affiliated with the hospital on campus and midwives could deliver babies at the hospital. As part of the prenatal treatment, it was standard practice for pregnant women to tour the hospital so they were familiar with and could choose the location of their birth (if there were no complications) or in case they needed to be transferred to the hospital last-minute in the low likelihood of an unforeseen complication once a woman went into labor.

My first reaction to the hospital tour was that it felt very sterile. I remember lots of white walls, fluorescent lights, heavy fire doors, and people sitting low behind desks. When we arrived at the labor-and-delivery unit, I recall there being softer colors on the walls and some oversized industrial sleeper chairs for fathers and family members. Nothing about it however beckoned me to deliver my most precious commodity in that place.

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I quickly concluded that the birth center was where I would be planning to deliver my child. I cannot remember which place I toured first. What I remember about the birth-center setting is that it was a prototypical medical office in front with waiting room, a toy area for children to entertain themselves while moms wait for their appointments, and the birthing rooms in the back with a separate entrance. The front part of the building was all business to me. It looked like a doctor's office. There were insurance verifications, co-pays, and routine administrative necessities.

The examination rooms were mostly like a regular doctor's office except with homey modifications. The ever-present examination table was there, but the lights were incandescent and tabletop fixtures, not industrial-strength ceiling installations. The placards on the wall showed typical doctor's office adornments such as fetus's growth stages and also inspiring comments about women. These environmental touches took the edge off the standard medical routine. The examinations by the midwives were what I regarded as standard gynecological exams and the midwives were all very informative, supportive, and friendly.

The back part of the building is what I would consider the inviting area. Here, there were three bed-and-breakfast type rooms, each decorated with an individual style. The one commonality is that they all looked like they could be in someone's home. There were wood-framed beds with colored bed linens, recliner chairs, and frilly curtains edged the windows. One room included a corner, all-important, jetted tub in it and a bathroom off to the side. The only sense that these were anything medically-oriented was a cart of medical supplies tucked into a corner in each room. The other two rooms were connected with a jack-and-jill bathroom that included an immensely deep, but otherwise standard-looking, bathtub in which women could labor and deliver. Connected to the three rooms was a nondescript lounging area for family members with a kitchenette so that the families could prepare simple meals. Oh yes, and there was artwork in the hallways, including pictures and even a sculptured torso of a pregnant woman.

If you are to deliver a baby, why wouldn't you come to a place like this, I kept asking myself in disbelief.

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Carmen Stitt, Ph.D. is Associate Professor of Communication Studies at California State University, Sacramento where she teaches mass media, health communication, and research methods. Her research examines how people acquire health information (more...)

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Allowing the Decision to Choose a Midwife