One hundred years ago, most American babies were born at home and delivered by the neighborhood midwife. By mid-century demographics had shifted significantly. The obstetrician had replaced the midwife, and the majority of newborns entered the world in a hospital. But as we begin a new millennium, it seems that we have come full circle. Midwives have made a strong comeback, and home birth is becoming an increasingly attractive option for many couples.
Deciding on the right practitioner and the location for your baby’s birth is dependent on a number of factors. If your pregnancy is high risk for any reason, then your safest option is with an obstetrician in the hospital. But if you are like most women, then the choice is primarily a personal one.
Physician Assisted Birth
Given a choice, some surveys show that by a large majority, women prefer to have an obstetrician deliver their baby, and that may be your first choice as well. However, a large number of family practitioners also are delivering babies, and many couples like the idea of an “all in one” doctor. The modern version of yesterday’s GP or general practitioner, they are the physicians who will provide primary care for the entire family.
Some doctors have moved beyond the traditional hospital delivery room, and can be found in birth centers, hospital birthing rooms and even more surprisingly, in the home. Although rare, doctors like Mayer Eisenstein, MD, who has run a family practice in Chicago for the past 30 years, may be on the forefront of a new era in medicine-the return to home-based birth.
“I don’t recommend a home birth for everyone because obviously, women with certain medical conditions are better off in the hospital,” says Eisenstein. But he points out that most women are healthy, and that problems are really a small part of birth.
“We always hear that home birth is dangerous because of potential problems, but in reality, that’s not true anymore,” he says. “With all of the high tech equipment we have now, I can, for example, talk to my surgical team over my cell phone while we’re en route to the hospital, and by the time we arrive, everything is completely set up for the patient.”
Five of Eisenstein’s six children were delivered at home, as well as all of his grandchildren, and he finds that he doesn’t get very many negative comments from his fellow doctors because he chooses to assist at home deliveries. “As time goes on, ” he says, “You develop credibility. People have respect for that.” Eisenstein’s practice has delivered over 14,000 babies, and just the sheer number alone has helped solidify that credibility.
Fewer than 50 physicians in this country currently deliver babies at home, but Eisenstein believes that is changing. Five doctors have joined his staff in the last three years, and three more will be joining in the next year.
Today’s midwives are well-trained professionals, although the differentiation within the profession can be confusing. Certified nurse midwives or CNMs are registered nurses who have completed advanced study in obstetrics, usually in a master’s degree program, and they may practice in all 50 states. They are an appealing option for couples that desire a more individual and holistic approach to childbirth, and a nurse midwife can deliver babies in the hospital as well as at home and in birth centers. While a CNM works independently, there is always a back up physician available, for consultation and/or if a complication develops.
“Here in Washington we’re fairly autonomous-in this state as well as in many others,” says Karen Camacho Carr, CNM, Ph.D, a nurse midwife who is also a consultant and educator. “We don’t have to be in practice with a physician. What we have to do is practice according to the standards of our professional organization which requires us to practice within a healthcare system that allows for physician consultation and referral.” Carr, who delivers primarily at a hospital, has a OB/Gyn consultant that she and the other midwives in her practice confer with on a weekly basis, and who will handle their cases that become high risk or co-manage cases that can still be handled by a CNM.
A direct entry, lay or licensed midwife is not a nurse and learns her trade through either apprenticeships or formal schooling. They generally deliver babies at home or at free standing birth centers. Many are certified and registered with the North American Registry of Midwives (NARM), as well as being licensed in their individual states. However, state laws vary considerably regarding direct entry midwives, and in most states licensed midwives are not required to have any practice agreement with a doctor.
Finally, there are also certified midwives (CM) or certified professional midwives (CPM). They are not required to be nurses although some of them are, and others may be direct entry midwives. Still others who become CPMs began their careers as physician assistants, physical therapists, or any of a number of educational routes. They are relative newcomers to the midwifery world, and generally deliver at home or at birth centers. Like direct entry midwives, their legal status varies from state to state.
A doula will not deliver your baby, but she can help you cope with your labor. Basically, a doula is a private labor coach, who will stay by a woman’s side for the entire time that she is in labor. Studies have found that women attended by doulas have shorter labors, fewer complications, and fewer problems with their baby. Doulas do not take the place of a woman’s partner, but they are there to help both members of the couple get through labor with a minimum of stress.