The Medical Minute: Growing number of women seek midwifery’s natural approach to care
A growing number of mothers in the U.S. are having perfectly healthy babies in safe environments but minus what was once considered a key ingredient – the doctor.
More than 45,000 women opted to give birth at home in 2020, a 19% increase from 2019, according to the U.S. Centers for Disease Control and Prevention. Others are giving birth in hospitals, but they’re opting for procedures that allow them to move during labor rather than being confined to a hospital bed.
In both cases, women are turning to midwives. Like obstetricians, midwives help mothers through pregnancy, child birth and what comes afterward. But midwives can help mothers give birth in locations other than a hospital room and use techniques different from what an OB/GYN offers. In many cases, obstetricians and midwives work hand-in-hand.
What exactly does a midwife do?
Different types of midwives provide various levels of care to women and babies. Certified nurse midwives like Katie Reynolds, one of five who work both at Penn State Health Obstetrics and Gynecology in Camp Hill and at Penn State Health Hampden Medical Center, are registered nurses with master’s degrees in midwifery. They’ve obtained special certifications and advanced training. They offer personalized care during pregnancy and childbirth, well-women care, and are licensed to prescribe a wide range of medications, including pain relief during labor and childbirth.
“One of the really cool and fun aspects of being a midwife is we can take care of women throughout the lifespan: when they hit puberty, through their early adult years, through pregnancy, through postpartum and all the way through menopause,” Reynolds said. “We are able to form life-long relationships and trust with our patients.”
Does choosing a midwife mean I’m choosing against an OB/GYN?
No. Reynolds has found that physician support within her practice is a big factor in her success.
“Our physicians are very respectful of our education and background. They speak very highly of us to the patients,” she said. “They are there when we need them, but otherwise let us run the show. You don’t find that everywhere.”
In some practices, midwives serve under the supervision of a physician, not collaboratively with them. In others, a patient with a high-risk medical condition may “risk out of midwife care” and be transferred to a physician. That’s not the case at Penn State Health Obstetrics and Gynecology.
“We consult with the physicians in our practice if someone has a medical condition we don’t feel is within our scope. They give recommendations. It doesn’t mean we can’t care for them,” said Reynolds. “We have such a good working collaboration with our physicians that we are able to continue caring for our patients through delivery and postpartum.”
Why work with a midwife in a hospital?
Working with a midwife in a hospital gives patients an opportunity to have a natural, physiologic, hands-off birth in a setting where resources are close in case of an emergency.
“In the home setting, the resources are more limited on what you can provide for the patient, especially if they have any medical issues or complications,” Reynolds said, adding that it is not uncommon for a home-birth midwife to transfer a patient to them during labor. “It could be a complication at home or a patient could decide they want more pain-control management. Having us as a resource makes it possible for the patient to continue midwifery care even though they are moving into the hospital setting.”
How does the birth experience differ with a midwife?
Many patients who seek out midwives for pregnancy and childbirth care are looking for an alternative to the more medicalized approach of a physician that includes continuous monitoring of the baby and not letting patients out of the bed.
“Midwives specialize in the physiological birth that our body knows how to do. We encourage movement throughout the labor process, walking around the unit, changing positions, getting in the shower,” Reynolds said. “We tend to be more hands-off and let nature take its course.”
Though physician support is clearly vital to their success, Reynolds believes the long-term appeal of midwifery care comes from nurses.
“We are used to being at the bedside and forming a relationship with the patient. As a nurse, you spend a lot of time with and caring for patients. We carry that with us as we become midwives, which makes a very big difference in our positive outcomes,” she said. “By listening to the patient, taking the time with a patient, we really try to form a good working relationship and understand where our patients are coming from.”
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