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By Lynette Tilley CPM, LDM
Since the beginning of time childbearing women have sought
the individualized care, advice and companionship of midwives.
Like their ancient predecessors, the modern midwife focuses
on the fundamental belief and understanding that pregnancy
and birth is a normal and natural process. Today’s midwife
is an autonomous health professional who specializes in the
complete and personalized healthcare of childbearing women
and their newborns.
The Midwifery Model
of care includes:
Monitoring the physical, psychological and social well-being
of the mother throughout the childbearing cycle
Providing the mother with individualized education, counseling
and prenatal care, continuous care during labor and delivery,
and postpartum support.
Minimizing technological interventions
Identifying and referring women who require obstetrical attention
(May 1996, Midwifery Task Force)
Types
of Midwives practicing in Oregon State:
Certified Nurse Midwives (CNM): This credential
requires all candidates attend a nursing education program.
In addition, each candidate must complete postgraduate hospital-based
midwifery training at an institution accredited by the American
College of Nurse Midwives (ACNM). Most Certified Nurse Midwives
practice in hospitals and free-standing birth centers.
Certified Professional Midwives (CPM): Midwives
with this credential have directly entered their training
without obtaining a nursing degree. This credential requires
candidates attend competency-biased midwifery education programs
accredited by the Midwifery Education Accreditation Council
(MEAC), ACNM certification Council (ACC) or PEP. Each candidate
must also complete a clinical component requiring out of hospital
clinical experience that is at least 1 year in length and
equivalent to 1350 contact hours under the supervision of
one or more approved preceptors. Most CPM’s practice
in home settings and free-standing birth centers.
Licensed Midwives: called Licensed Direct
Entry Midwives in the state of Oregon, attend births in homes
and free-standing birth centers. LDMs must meet specific educational
and experience requirements, pass a national exam, maintain
continuing education, and participate in peer review. They
must follow practice standards and risk assessment protocols
developed by the Oregon Board of Direct-entry Midwifery and
renew their license annually. Licensed midwives may perform
certain medical procedures such as suturing, administering
specific medications or IV fluids as well as the use of oxygen.
Unlicensed Midwives: Births
can legally be attended by unlicensed midwives in Oregon State.
Most unlicensed midwives have developed their skill and education
through self study and/or apprenticeship. Training and skills
can vary from midwife to midwife. Unlicensed midwives may
not legally perform medical procedures such as suturing, administering
medications or IV fluids.
Is midwifery care
safe?
Yes! Midwives provide the primary care for approximately 70%
of all births in other developed countries such as the Netherlands,
Sweden, New Zealand and the UK. In fact, low-risk women in
the UK are encouraged to have their babies at home or in birth
centers with midwives because obstetricians are recognized
as specialists in high-risk pregnancies. Conversely, in the
United States only 8-10% of all births are attended by midwives.
Despite all of our technological and medical advancements,
when compared with developed countries that utilize the care
of midwives, we rank surprisingly low in maternal and neonatal
morbidity and mortality. Countries that readily offer midwifery
care enjoy significantly better outcomes for moms and babies.
In 1990, The World Health Organization declared that birth
was safest when utilizing the care of midwives for pregnancy
and childbirth.
If I see a midwife
should I see a doctor too?
Midwives, obstetricians, and family physicians are all considered
primary caregivers. You could have either a midwife or a doctor
for you pregnancy, birth and newborn care. However, having
two primary healthcare providers would be considered a duplication
of care.
How is the care of
a midwife different than an obstetrician?
Obstetricians are doctors who are extensively trained in pathology
and surgery. The focus of their care is to control and treat
illness. The service they provide can be very helpful for
pregnant women who are struggling with health concerns which
put them at risk for a complicated pregnancy and/or birth.
However, for the vast majority of women who give birth, pregnancy
is a normal event.
Midwives are primary healthcare providers also trained to
identify illness and complications during pregnancy and birth.
Their fundamental focus and approach is based in the belief
that pregnancy and birth is a normal physiological process
rather than a potential medical event or emergency.
Choosing a Midwife
Finding a midwife who is appropriately skilled and compatible
with your personality and birthing goals is crucial. You can
begin your search by asking friends or acquaintances for recommendations.
You can also contact one of the national midwifery agencies
for referrals (see below). It is very important to meet and
develop a rapport with any midwife you're considering. You
should feel you can trust and rely on her. She will, after
all, be instrumental to the success of your home or hospital
birth. Here are just a few questions that you may want to
incorporate into you discussions with her:
Why did you become a midwife?
What is your training?
How long have you been a midwife?
Where do you provide your services? In hospitals, birth centers
and/or in homes?
What equipment and/or medications do you carry with you?
Do you work with other midwives or healthcare professionals?
What prenatal and postpartum care do you provide? Does it
include any home visits?
If you are away, and I go into labor, who should I call?
What are your fees? What does it include? When should it be
paid? Do you accept insurance?
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