expecting
 
Understanding Midwifery

Giving birth to a baby can be one of the most powerful, joyful, and deeply gratifying acts a woman ever experiences. Women in nursing homes who can’t remember their own names can tell you their birth stories in vivid detail. An empowered birth can provide a mother with a new understanding of life, a new source of wisdom, a new source of strength to draw upon during times of difficulty – gifts that will equip her for the challenges of parenting.

When a woman labors and births in a safe, secure, nurtured, affirmed and unhindered environment, her body produces hormones to allow her to "release" to the birthing experience.

Women who experience labor and birth in this purely natural state surrounded by nurturing and trusted companions and attendants tend to have very positive and wise things to say about childbirth. Fear can interfere with the production of endorphins - which act as natural opiates during the birth process.  Fear jump-starts the body’s adrenaline response (the "flight or fight" response), which inhibits the uterus from doing its job with optimal efficiency, making childbirth longer and more painful. Many women have found midwifery can help make childbirth a more positive experience.

What is a Midwife and the Midwifery Model of Care?

• A midwife is educated to care for a woman from the onset of menstruation through menopause;

• Midwifery care emphasizes personalized, family-centered care focusing on patient education, wellness and preventative care, and patient/consumer choice;

• The midwifery philosophy is that pregnancy, birth and a woman’s transition through life’s stages are normal and natural events;

• Midwifery care encourages minimal use of technology and technological intervention;

• Midwifery care is based on emotional and hands-on support of the woman throughout the birthing process; and supports medical referral when indicated.

Perhaps most important, the midwifery model of care sees the needs of the baby and mother as inextricably linked. A midwife supports the womans’ decision making power, welcomes both informed and intuitive self-analysis, and educates and empowers women to care for themselves. Midwifery reduces the incidence of birth injury, trauma, and Cesarean section.

Midwifery in Connecticut

There are two main types of midwives currently practicing in Connecticut: independent midwives, credentialed as Certified Professional Midwives; and Certified Nurse Midwives, licensed by the State of Connecticut.

Certified Professional Midwives (CPMs) train through a variety of educational routes including midwifery training programs accredited by the Midwifery Education Accreditation Council (MEAC), apprenticeships, self-study, and university coursework.  CPMs earn their certification through the North American Registry of Midwives (NARM), a professional organization that evaluates midwifery knowledge, skills and experience using a written examination and a hands-on skills assessment.  To achieve the CPM credential, a midwife must demonstrate knowledge and expertise specific to out-of-hospital settings.  In Connecticut, CPMs practice exclusively in private homes.

Certified Nurse Midwives (CNMs) are registered nurses who have graduated from a nurse-midwifery education program accredited by the American College of Nurse Midwives’ (ACNM) Division of Accreditation (DOA). Most CNM programs are from 16 to 24 months long and provide a wealth of experience in well woman care during pregnancy and throughout the female life cycle. The CNM may provide routine gynecological exams; take PAP smears; order ultrasounds, bloodwork and mammograms; and the diagnose and treat minor infections and gynecological problems.   To obtain credentialing the CNM must also pass a national certification examination and attend continuing education to maintain her credentialing.  In Connecticut, CNMs generally practice in birth centers or hospitals although a small number do work in private homes.  Connecticut CNMs have prescription writing authority and are covered by most insurance plans. A back-up physician, generally an obstetrician/gynecologist, is made available at all times in the event that collaboration or referral is necessary for one of her patients.

The Legal Status of Midwives

CNMs are licensed in all 50 states and most states use the ACNM’s certification process as the licensing mechanism.  CPMs are licensed in 18 states which use the NARM’s certification process as the licensing mechanism.  While CPMs provide quality care, they are not yet regulated in Connecticut.

Consider the following facts:

• The United States spends more money per capita on maternity care than any other country in the world, yet we rank 25th internationally for infant mortality.

• The United States has consistently ranked at or near the bottom of all industrialized nations for infant mortality for two decades.

• In 2000, Connecticut CNMs attended approximately 5,000 births in the state and CPMs attended approximately 200 births.

• More than 6,000 CNMs practice in all 50 states and many developing countries. In 1998, CNMs attended 277,811 deliveries, mostly in hospitals; 9 % of all US births. Today, approximately 500 CPMs are practicing in the US.

• Midwife-attended births are associated with:

• fewer pre-term births;

• fewer low birth weight babies;

• fewer interventions into the birth process;

• lower Cesarean section rates; and

                    • lower medical costs.

Books

Birth as an American Rite of Passage, by Robbie E. Davis-Floyd (1992).
The Thinking Woman’s Guide to a Better Birth, by Henci Goer  (1999).
The Scientification of Love, by Michel Odent (2000).
The Five Standards for Safe Childbearing, by David Stewart (1997).

Resources

www.fominct.org or 860.688.4703

Friends of Midwives is a consumer advocacy group, consisting primarily of families who have been fortunate enough to have had midwifery care in pregnancy and birth and who feel strongly that choices in childbirth must be available to all families.

www.Connecticutmidwife.org

The Connecticut Chapter of the American College of Nurse Midwives brand new web site provides a list of midwifery practices and birth sites in CT and information about midwifery services. Visit the American College of Nurse Midwives’ site at www.midwife.org.

www.ctbirthcenter.com

The Connecticut Childbirth & Women’s Center is the area’s only freestanding childbirth center, 203.748.6000.

www.stmh.org

In January, 2000, St. Mary’s Hospital in Waterbury celebrated the first birth in The Birthplace, Connecticut’s only in-hospital birth center, 203.575.7270.

www.birthcenters.org

To find a birth center nearest you, visit the National Association of Childbearing Center’s web site.

Sharon Reilly is the current president of Friends of Midwives in Connecticut, a non-profit organization which seeks to educate families, health care providers and policy makers about the benefits of midwifery care for women, babies, and society.

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