Choosing a Caregiver for Pregnancy, Labor, & Birth:  Part 2

There are several kinds of health care professionals who can provide prenatal care, attend births, and deliver babies.

Philosophy of birth

There is a range of philosophy and practice amongst individual practitioners, but they fall at varying points along a continuum of beliefs about birth. These are often referred to as the ìmedical modelî and the ìmidwifery model,î although thatís a generalization, and you would want to interview your potential care provider to get a sense of their personal philosophy.

Medical model:

There are potential dangers and risks inherent in pregnancy, labor, and birth. The role of the caregiver is to attempt to prevent problems, to remain aware of possible complications and variations that may arise, monitor and test for these issues, and intervene quickly to prevent further complications.

Midwifery model:

Birth is a natural and normal physiological process which varies from woman to woman. The role of the midwife is to monitor the motherís physical, psychological, and social well-being, and provide education and support. If problems do arise, they explore alternatives for coping with the issue. They may offer ideas for things the mother and her support people can do to resolve the problem, may offer medical treatments they can perform, may refer to complementary medicine providers, or may transfer the motherís care to a physician if mom needs the specialist care of an obstetrician.

For more on midwifery model >> 

---

Intervention Rates / Safety of Midwifery Care

For these statistics, overall averages includes all births, the great majority of these births are physician attended. CNM is certified nurse-midwives under the supervision of a physician; the vast majority of these births were in the hospital. CPM is certified professional midwife rates at home births.

Note that midwives only see low-risk clients, so some of the difference in rates is based on the initial health status of their clients.

Epidurals. Overall: approximately 2/3 of birthing mothers (as high as 90% at some hospitals, 40% at others). CNM: 14.6% CPM: epidural is not available at home births. Some CPM clients are transferred to hospitals, and some choose epidural once theyíre there. So, for women who received care from a CPM, 4.7% had epidurals at some point in labor.

Episiotomy. Overall: a few years ago, rates ranged from 10% - 80%. The incidence has dropped hugely, so that rates are typically <25% now. CPM: 2.1% Cesarean section. In 2002, 24% of all births in Washington. 26.1% nationwide. Rate among CNMsí clients: 11.6% Among CPM clients: 3.7%.

Vaginal birth after cesarean. Nationwide: 12.7%. CNM: 68.9%

Infant mortality: In 1991: 8.6 per 1000 nationwide. CNM: 4.1 per 1000. In 1998, the National Center for Health Statistics determined that, after controlling for risk factors, the risk of infant death was 19% lower at births attended by CNMís than by physicians. Risk of neonatal mortality within first 28 days was 33% lower for CNM-attended births. This is believed to be attributed to prenatal care which involved more patient education, and to CNM presence throughout labor. CPM: 1.7 per 1000.

A note about group practices:. Many providers work in a group practice, and take turns being on-call. When choosing a practice, ask whether all your prenatal appointments will be with a primary care provider, or whether you will meet with several providers. Ask whether you would have a primary caregiver who would attend your birth if at all possible, or whether you would be attended by whomever was on call at the time. Ask how many caregivers are in the group, and how many clients they serve.

 

---