Tuesday, May 13, 2014

Frequently Asked Questions About Midwifery

Champlain OB/GYN is excited to add Certified Nurse Midwifery care to our practice. All changes bring questions, so we’ve asked the Fletcher Allen midwives to answer a few commonly asked questions.


I’m confused, I thought midwives delivered babies at home.  Do they deliver babies at Fletcher Allen?


Many people think “home birth” when they hear the word “midwife,” and are surprised to learn that midwives deliver babies in the hospital. In fact, Certified Nurse Midwives (CNMs) have practiced at Fletcher Allen for over forty years, and have delivered thousands of babies in Fletcher Allen’s Claire M. Lintilhac Birthing Center! The Fletcher Allen midwife team is available 24/7 and provides prenatal, postpartum and well-woman care in the office, and labor, birth and initial postpartum care in the hospital.


Most midwife-attended births in the United States take place with Certified Nurse Midwives in hospitals, just like at Fletcher Allen.  CNMs are healthcare professionals who specialize in assisting normal, uncomplicated births. They are Advanced Practice Registered Nurses with graduate education in midwifery. They have graduated from an accredited nurse-midwifery education program, which includes a university degree as well as hands-on clinical training by practicing CNMs. They also have passed the national certification exam of the American Midwifery Certification Board (AMCB).  In Vermont most home birth midwives are either Certified Professional Midwives or Naturopathic Doctors, who go through different education and certification processes. 


Why would a woman choose a midwife?


Many women choose to give birth with the help of midwives because of a desire for individualized care and a unique birthing experience. The word “Midwife” literally means “With Woman.”  The midwifery model of care is evidence-based, promotes listening to women and respecting their desires, and minimizes the use of medical interventions unless necessary or requested by a woman. Midwives believe a woman and her family deserve the knowledge they need to make good health choices for themselves. A midwife does not simply tell a woman what to do, since what is right for one person may not be right for the next. Instead, a midwife offers information and helps each woman decide what is best for her and her baby, building a healthcare relationship grounded in trust and respect.


Midwifery care also produces improved health outcomes. National research indicates that women who choose a Certified Nurse Midwife have lower rates of induction of labor, cesarean birth, and perineal trauma, and higher rates of breastfeeding.  CNMs can prescribe medications and order diagnostic procedures when appropriate and medically indicated. 


Midwives use the same schedule of prenatal appointments and routine testing in pregnancy, but they tend to spend more time with women during prenatal visits, and more time by a woman’s side in labor – supporting her and watching for any health concerns.  They provide exceptional, individualized care to women across the lifespan, through pregnancy, birth, postpartum and beyond.


What if I have a complication that requires an obstetrician?


As a practice based in an academic medical center, the Fletcher Allen Nurse Midwives collaborate seamlessly with Obstetricians, Maternal Fetal Medicine specialists, and Pediatricians when needed. If a woman has a complication during pregnancy, the midwives will consult with collaborative obstetricians at Champlain OB/GYN and Fletcher Allen. During labor or prenatal assessments in the birthing center, they may consult with Fletcher Allen Obstetricians, who are available in the hospital 24/7.  If need arises for a cesarean, vacuum or forceps-assisted birth, a midwife stays with the woman and her family in a supportive role, and a Fletcher Allen Obstetrician delivers the baby.


Do I have to have an un-medicated birth if I use a midwife? I think I might want an epidural.


Midwives offer a variety of pain relief options in labor, including massage, relaxation, use of a tub, and epidural anesthesia if desired. Using a midwife does not mean a woman must have un-medicated childbirth. Approximately 45% of Fletcher Allen midwifery patients desire or need some form of anesthesia during their births, and epidurals are readily available.


I’m hoping for a natural childbirth. Will a midwife stay with me in labor to help me get through it?


One of the hallmarks of midwifery is labor support. The Fletcher Allen midwives set up their call days in 24-hour shifts to help provide continuity of care during long labors, and have the next day off so they are able to stay up to provide support. Midwives are directly involved providing care during labor, encouraging movement and position changes to promote labor progress, and using hands-on support, hydrotherapy, and gentle words to guide pain coping. The Fletcher Allen midwives stay attuned to their staffing and their total number of patients so they can provide direct support as much as possible, when desired.


If you have additional concerns please talk with us at your prenatal visits!  The birth of your baby is also the birth of you as parents and the growth of your family.  Sometimes navigating this transition can feel overwhelming. The Doctors and Midwives want you to feel safe, supported and informed about your care.

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