Parents today have more options than ever before when deciding who will provide their prenatal care, who will attend their baby’s birth, and where the birth will take place. Many of these options indicate a positive shift in the way our culture views maternity care: Parents can (and should) be actively involved in selecting the type of birth they want for their family. Unfortunately, the overwhelming number of choices, combined with a lack of cultural familiarity with birth itself, sometimes leads parents to choose a “default” birth (read: OB-attended birth in a hospital with standard medical interventions) rather than thoroughly exploring their options.
The primary goal of Healing Hands Chiropractic’s pregnancy and childbirth workshops is to demystify the process of birth and the choices involved, allowing parents to choose the options that are best for them and for their baby. Understanding the difference between types of care providers is an essential part of planning the birth you want.
In the United States today, the vast majority of births are attended by an obstetrician (OB), a medical doctor who specializes in pregnancy and childbirth. Obstetricians are trained to manage low-risk pregnancies and deliveries, but are especially skilled at handling complications. They can attend vaginal births as well as perform cesareans. Among OBs, there may be a wide variety of attitudes toward pregnancy and birth. If you are considering care with an obstetrician, it is important to make sure that his or her philosophy on birth is similar to your own.
Midwives are extensively trained in providing care for low-risk pregnancies and deliveries. A midwife practicing in a hospital is usually a certified nurse-midwife, or CNM. CNMs are registered nurses who have additional training and experience with maternity care. CNMs in hospitals generally work in conjunction with one or more obstetricians, and can consult with them or even transfer patients to their care should complications arise. Many CNMs tend to have a more hands-off, holistic attitude toward pregnancy and birth, though this is not always the case. A CNM practicing in a hospital is often subject to institution policies, including standard procedures for length of labor after admission to the hospital, eating and drinking in labor, and management of complications.
Midwives who practice outside of the hospital have different credentials depending on licensing regulations in each state. (In New Hampshire, the designation is CPM, or Certified Professional Midwife.) Unlike hospital-based professionals, Direct Entry Midwives are trained in birth first, medicine second. Even more than a CNM, a CPM tends to regard pregnancy and birth as a natural, healthy process that requires little to no intervention. (Midwives have been known to say that they do not “deliver” babies, they just “catch” them.) Direct Entry Midwives attend births in free-standing birth centers and at home. They are trained to watch for and manage complications, and to transport clients to the hospital when necessary. Their labor bags include medical equipment to prevent or manage maternal hemorrhage, to provide sutures in the event of a perineal tear, and to resuscitate a newborn. An out-of-hospital birth for a healthy, low-risk mother is neither dangerous nor irresponsible. In several studies, home birth has actually been shown to be safer than hospital birth, because the mother is not subject to standard procedures that may lead to complications.1
Doulas are labor support professionals. They are not responsible for the medical aspects of birth, but provide emotional and psychological support for the mother and her birth partner. A doula is also trained to interact professionally with hospital staff, and can act as an advocate for the mother should the need arise. A doula generally arrives earlier in labor than other birth attendants, often supporting the mother while she labors at home and then traveling to the hospital with the parents. She can help with the initiation of breastfeeding and may also offer additional postpartum support. (For more information, including the distinction between labor doulas and postpartum doulas, please check out Doulas of North America: http://www.dona.org/mothers/index.php)
Practitioners at Healing Hands Chiropractic regard pregnancy and childbirth as natural processes in which both parents should be involved and educated. For more on birth choices, consider an upcoming childbirth series or early pregnancy workshop. Email email@example.com for schedule, rates, and registration information.