April 7, Rainbow of Choices

This post is largely based on a brief article "Spectrum of Caregiver Choices" by Barbara Stratton of Baltimore ICAN. She believes it's important to understand your choices to promote the healthiest birth. Not every choice is appropriate for everyone, but in a relatively uncomplicated pregnancy they can all be seriously considered, and even compatible with certain complications. Homebirth might sound really "out there" if you've never really looked into it, but women all over the U.S. are turning to it in increasing numbers for very practical reasons. It's not an alternative lifestyle thing anymore.

A-----B-----C-----D-----E

A: homebirth with midwife
B: independent, freestanding birth center staffed
by midwives (not a hospital wing that calls itself a "birthing center")
C: independent midwife with a hospital birth
D: midwife as part of an OB practice
E: OB

Quoted material from Barbara's article, the rest mine.

"Generally, the farther left you stay on the spectrum, the fewer interventions (including cesarean) you will have with your birth. For example, a homebirth midwife may transfer 5% of her clients to the hospital for cesarean surgery while there are reports of obstetricians with 50% cesarean rates."

"It is important to understand the different types of care you get according to what type of provider you select. A laboring woman who has hired an OB for her care and whose baby is malpositioned (sunny side up for example) and having a stalled labor as a result will typically receive Pitocin to strengthen contractions. The Pitocin causes unusually strong labor pain and often results in the mother getting an epidural for pain relief and then being confined to bed." This may render her "unable to move in ways that help the baby navigate her pelvis." After a trial of this sort, it's not unusual to then move on to a cesarean.

"A hospital based midwife may suggest position changes to help the baby correct his presentation before resorting to Pitocin augmentation. A homebirth midwife may first counsel her pregnant clients on ways to avoid having a malpresentation to begin with (some hospital based midwives do this as well) and then in labor may suggest labor positions to help the baby rotate" as well as employing a number of other remedies and techniques to move past the barrier of difficult positioning. The mother attended by a midwife is also virtually guaranteed to be given the luxury of time to figure out what works for her.

"If you select a caregiver farther to the right of the spectrum then it is especially important to hire a doula who is well versed in helping babies be born and ensure that your doctor or midwife will allow you to use any of the remedies that may become necessary." I.e. they can help you negotiate the stress and urgency imposed by a hospital environment to achieve a more gentle and healthful birth.

Please note that unassisted childbirth is not on the spectrum. Barbara did not include it (I didn't ask why) and I would not include it. It is my personal conviction that planning an unassisted birth is unnecessarily risky. Many events occur in a birth that can be handled easily by a midwife but that could go wrong without a little proper attention or birth "first aid". Of course, babies are born at home and in taxis and such by accident and most do fine, but I'm not going to recommend it here.

This article is one person's survey of her local birth choices in Madison, Wisconsin. Find out what the choices are in your area.
http://www.thedailypage.com/isthmus/article.php?article=5245

Shari