by Lois Trezise
It’s natural in the course of human affairs for the pendulum to swing in one direction or another. Advances in scientific knowledge and medical technology during the 20th century spurred a trend toward treating births as a medical situation. This was understandable given the excitement over the improvements in anesthesiology, surgery, and antibiotics, among other improvements that definitely saved the lives of mothers and newborns. But as it reached a point where the labor and delivery process came to feel depersonalized, women began to react against it.
Over the last 30 years, women have advocated very strongly for birth to be a more homelike experience. Thus, the role of midwives has grown significantly. According to a National Vital Statistics Report, births attended by midwives have increased by more than 100,000 per year from 1996 to 2008, and now account for 11 percent of vaginal births and 7.5 percent of all births in the United States.
Midwife is an old Anglo-Saxon word meaning “with woman” so actually even a man can be a midwife (although the American College of Nurse Midwives reports that less than one percent of its members are male). It’s somebody who likes to be with women in labor, keeping them company and helping to watch over the progress of their labor and accompanying the mom and the baby safely. It’s about listening to women and what their wishes are and trying to have a balance between medical practice, which has lots of good scientific aspects, and the intuitive side for women’s wishes of how they want their labor experience.
I received my certification in 1978. Many of my mentors were nurses who went for midwifery training after having children of their own and realizing they were looking for a positive framing of the birth experience. Some of the things they changed included encouraging women to walk around during labor, and being in a vertical position so gravity could aid birthing. They created a screening process that assessed whether a woman was low or high risk and worked with them accordingly. This allowed women to drink or eat lightly in early labor if they were low risk, and removed the requirement that women in labor immediately need to have an IV even if they don’t want it. They were also very active in establishing centers that offered out-of-hospital births or to make a hospital birth more homelike. BMH’s own Birthing Center is borne out of that philosophy. The rooms are decorated attractively with appealing furniture. There are windows that look outside so you’re not only experiencing artificial light. All of the up-to-date technology is there but anything that’s needed for emergencies is put away in cabinets. The beds are more adaptable than they used to be so positioning can be changed for the mother’s comfort. Labors are more respectful of families, quiet and without a lot of interruption.
Nurse midwives have training as registered nurses as well as in midwifery, putting us into the category of a midlevel provider that is becoming more prevalent in health care. Our training is very comprehensive. It includes general medical background, surgical procedures, pregnancy during the prenatal period, labor and delivery, the post-partum period, taking care of the newborn, family planning and well-woman care. We actually do exams for women from the first time a young woman needs to have an exam up until they are in their 70s or 80s. That continuity with families throughout the life cycle is important. One of the guiding points of our philosophy is that we affirm labor and birth as a normal process for most women, unless it happens to prove itself otherwise.
It’s important for families coming to us to have a fundamental idea of what we know. Then they can make their decisions for how they want their birth experience to be accordingly. Some people will say they want something done right away to get contractions going. We’ll often try to wait a certain period of time to let the body do it. We’ll encourage people to walk around or do things that are kind of low-profile but might help stimulate contractions, and offer lots of options that work within the philosophical framework of the family. If it comes to the point, however where it’s necessary for some kind of medical support we have a good relationship and mutual trust because of the continuity. Just to give an example: a woman’s water breaks but she doesn’t go into labor, which increases the chance of infection for the baby. If the mother isn’t aware of that she probably won’t seek medical assistance. But if you recognized that the risks are going up the longer you wait, we can work with that. Just because a nurse midwife has specialized training doesn’t mean we view births as risky or that all labors and births are the same. Even a healthy woman with a labor that stops progressing or ends up requiring a Caesarian can have a really positive experience if she is properly prepared and supported.
Ultimately, it’s a woman’s job to advocate for her own needs and explore all options for her care. Giving birth is a heroine’s journey. For some women it’s easy and for many others it’s challenging but your midwife is present with you every step of the way.
Lois Trezise is certified nurse midwife with Brattleboro Obstetrics and Gynecology, a member of the BMH Physician Group.