Choosing your Midwife
Informed choice means that you, as a consumer, do your homework. When you interview the midwife you are considering for prenatal, birth and postpartum care, there are some questions you may ask. The answers will help you decide if this midwife is the right provider for your family’s “great expectations.”
Review the list below and write down any other questions you may have. Share them when you interview your midwife. No question is out of line if it is important to you.
Metabolic Newborn Screens are just one of the newborn screens available to you with a licensed midwife.
How long have you been working as a midwife?
What is your license and/or certification?
How many births have you attended?
What is your philosophy of birth?
Do you help women birth at home, in a birth center or in a medical facility?
Who comes to the birth with you?
What supplies and equipment do you bring to the birth?
How did you receive your training?
What do you do if you have more than one mom laboring at the same time?
What do you do for pain relief if it is needed?
Do you do VBAC’s, water birth, breeches, or twins?
Do you provide care for the newborn immediately after birth?
Do you do newborn metabolic screening, congenital heart defect screen (CCHD) and hearing screening?
How do you handle emergencies with either mom or baby?
What is your relationship with the local medical community?
What is your relationship with the other midwives in our community?
Quality Improvement Committee
The midwifery community, their clients, the adjunct healthcare providers who interface with midwives and the public need a respectful, confidential space to air grievances related to midwifery services. The QIC will offer an avenue outside of the formal complaint tract in place through the Idaho State Board of Midwifery.
The QIC will be mindful to reinforce the IMC mission and purpose of promoting competent midwifery practice, providing opportunities for training and continuing education, promoting communication between midwives and between other professional and non-professional groups concerned with improving perinatal outcomes, and helping assure safe, quality childbirth practices for Idaho families. Our commitment is to helping midwives improve their practice and their future outcomes.
We are ready to receive your issues, concerns or complaints regarding an Idaho midwife or student, whether you are a consumer, midwife or other health care professional, or a member of the general public.
We are asking you to follow this procedure for filing your concern/complaint:
1.) Please file your concern/complaint in writing by sending the below information to:
2.) Please include the following information:
Your name and contact information.
Provide names and contact information for all parties involved.
State clearly the problem or concern. Please be specific and objective in describing the incident or problem and give dates when the incident or problem occurred.
What steps have you already taken to address/resolve the issue, and the results thus far.
What you feel is necessary to resolve the situation to your satisfaction.
After your written concern has been received by the Chairperson, the committee will begin it’s work, which includes sending copies of the written concern to the committee members, as well as a copy sent to the midwife/student/person in question.
Thank you for all your hard work in behalf of the birthing families and professionals throughout Idaho.
Midwifery Model of Care
The midwifery model of care has been found to be a safe and effective alternative to the medical model of childbirth which is commonly seen in North America today.
The midwifery model of care views pregnancy and birth as a normal, healthy process and treats it as such, rather than as a disease, illness, or medical event. Midwives are experts in normal birth. However, they are also trained to recognize early warning signs of complications and refer to other health care specialists appropriately.
The midwifery model of care offers skilled, individualized care throughout the childbearing cycle of pregnancy, labor and birth, and the postpartum period. This includes caring for the social and psychological aspects of the mother, as well as the physical, and offers informed choice regarding tests and procedures which may be done.
“Midwife” means with woman and this requires time. In the midwifery model of care, the midwife attends the mother continuously throughout her labor and birth, offering encouragement, comfort, and other means of supporting the birthing woman. This greatly reduces the need for medical intervention and also increases the empowerment and satisfaction women feel regarding their births.
The midwifery model of care means freedom to the birthing mother:
freedom to choose her birth attendants
freedom to make informed choices regarding her care
freedom to labor where she feels safe and secure
freedom to eat, drink, and move about as she pleases during her labor
freedom to bathe and labor in the water
freedom to give birth in whatever position feels right to her
Evidence-Based Maternity Care: What It Is and What It Can Achieve
By Carol Sakala and Maureen P. Corry
As midwives, we strive to give the best possible care to our moms and babies. Ideally that care should be based on evidence rather than opinion, what is convenient, or what is more lucrative. Evidence-based maternity care is determined by the systematic review of the best available research to ascertain which practices are effective, least invasive, and most likely to cause limited or no harm to expectant mothers and their infants. This report addresses physiologic maternity care; maternity practices which are overused in modern maternity care, but which expose mothers and babies to rosk of harm while contributing little or no benefit; and maternity practices which are effective, but underused in current maternity practice. The report also addresses the financial impact of today’s maternity care as well as that of evidence-based maternity care.
Physiologic maternity care provides both short term and long term benefits to mothers and babies. Such care cooperates with how the mothers’ and babies’ bodies work throughout the childbearing cycle and facilitates the process of labor, birth and establishment of breastfeeding. Any interruption of these natural processes can be justified only if the practice is shown to do more good than harm. Midwives generally provide a physiologic approach to maternity care, with attending benefits for moms and babies. Long term benefits of physiologic maternity care include avoiding the risk of harm resulting from medical interventions used during the perinatal period.
Overused interventions in maternity care today include induction of labor (41%, medically attempted), epidural analgesia (76%), and cesarean section (32%), based on a 2005 survey of hospital births, Listening to Mothers II. These interventions have increased greatly in recent years and while appropriate in a small percentage of births, should not be used in large numbers of birthing women because they are associated with increased risk to moms and babies. Women have the right to make an informed decision regarding such interventions, based on their safety and effectiveness in addition to the individual circumstances. Other overused interventions are continuous fetal monitoring (71%), rupture of membranes (65%), episiotomy (25%) and a number or routine prenatal care practices. Johnson and Daviss (2005 study) cite the rate of such interventions in CPM managed births as the benchmark “for what the majority of childbearing women and babies who are in good health might achieve.”
Underused interventions are generally noninvasive, effective and have no known or minor risk of harm to mother and infant, and as such, are appropriate for general use. These include use of prenatal vitamins and stopping smoking in pregnancy, ginger for nausea and vomiting, methods to avoid preterm birth, external version, continuous labor support, noninvasive methods of pain relief in labor, delayed and spontaneous pushing, pushing in a position other than lying on the back, delayed cord clamping, early skin-to-skin contact, assisting in breastfeeding initiation and duration, and others. The financial impact on families of such care is minimal, with many incurring little or no cost. Evidence for VBAC is also presented.
Currently, the care of birthing mothers and their newborns is the most common reason for hospitalization today, with a price tag far greater than for any other single hospital condition. Overused interventions greatly increase the cost of maternity care while exposing mothers and babies to increased risk with little or no benefit. Conversely, underused interventions cost much less and convey benefits with minor or no risk to mothers and babies.
Barriers to implementing evidence-based maternity care revolve around financial considerations, specialist orientation for care of most low risk mothers, opinion-based care as the “usual pattern” of maternity care, loss or lack of professional knowledge and skills for physiologic maternity care (due to limited exposure), and quite a number of other factors.
In conclusion, I found Evidence-Based Maternity Care a very useful resource and definitely worth the read. Because the publication contains so much information, I have presented the high points only.
The entire text of Evidence-Based Maternity Care: What It Is and What It Can Achieve, by Carol Sakala and Maureen P. Corry (the 2008 Milbank Report) may be downloaded here.
Article review by Merrilyn Reeves, LM, CPM