Midwife-Led Maternity Care on the Rise
A slow but steady increase in the use of midwifery services is being seen nationwide, including Connecticut. In a time of heightened health and environmental awareness, people are taking greater responsibility for their wellness and mothers-to-be seem to be seeking the more personalized, less intervention-oriented care that midwives tend to give their patients. As women strive to control and relax in their changing bodies, a growing number of expectant mothers are using midwives and other complementary services in the U.S. for routine care.
According to the U.S. Department of Health and Human Services, the 2012 cesarean section (c-section) delivery rate equaled close to one-third of all births. Connecticut was above the national average in 2010 with a 35.2% c-section rate, the eighth highest state rate in the U.S. (CDC NCHS, “Births: Final Data for 2010”). In Fairfield County, Connecticut Department of Public Health data shows that St. Vincent’s Medical Center in Bridgeport displayed the highest rate with 44.5% in 2007, followed by Bridgeport Hospital with 39% and Stamford Hospital at 38%.
Of all U.S. births, 98.6% occurred in hospitals with certified nurse midwives (CNM) attending 7.6% overall. The American College of Nurse-Midwives has voiced its hope that CNMs and certified midwives (CM) will attend 20% of all births in the U.S. by the year 2020. St. Vincent’s in particular has made a concerted effort to change its c-section rate, with a mother-and baby-friendly emphasis in its maternity wing and a new birthing center supported by midwifery services.
Midwives can deliver at hospitals, birth centers or at home, giving mothers-to-be more birthing options. As part of regular medical prenatal checkups, the midwives take time to consult about nutrition, exercise, holistic treatments, emotional well-being and preparations for birth to increase the chances of a low intervention birth.
The increased demand for midwives can be attributed to physical and emotional factors. Women seem to be reacting to the high c-section intervention rates with a growing desire to feel empowered in their decision to have a more natural birth, according to Sarah Najamy, CNM, of Shelton-based Circle for Life Midwifery. The private, full-scope midwifery practice she founded with Paula Cate, CNM, focuses on a whole approach not only for pregnancy but also well-woman care.
“What we represent is choice,” Cate emphasizes based on her 30 years of experience leading midwifery groups. “The more a woman participates and decides, the stronger she feels during the birthing process and after, even if it is a c-section. If she doesn’t have this opportunity to feel heard and supported in the childbirthing, then that can rob her of the self-confidence she could have had going through that experience.”
With increased time exposure to each patient, the midwife may also be more aware of and address subtle physical and emotional pre- and postnatal changes. Midwives are present more in the delivery room supporting the laboring woman. As nurses, CNMs can administer medications and act as the patient’s advocate with the obstetrician if further medical interventions are needed. In exploring the possibility of using a midwife, it is important to note that there are several certification levels and medical capabilities with CNMs, certified midwives and certified professional midwives all providing different levels of care.
Najamy, who began her midwife journey in 1987 after many years as a LPN and RN, emphasizes how much has changed since she began practicing. “Back in the 1970s, there was much more opposition to midwives than there is now. Now, we are an accepted part of the medical community. Paula and I work very well with our collaborative physicians.” As a sign of that collaboration, The Birthplace at St. Vincent’s Medical Center opened its doors with Najamy and Circle for Life Midwifery in December 2012 as the only in-hospital birthing center offering midwifery services in Fairfield County. Over the years, both Najamy and Cate found that educating the public and the word-of-mouth support of patients was key to the local medical community’s acceptance.
With the increased integration of midwives is a parallel trend to use other holistic services such as a doula and hypnobirthing to support a healthy pregnancy, labor and delivery. According to DONA International, a doula provides “continuous physical, emotional and informational support to the mother before, during and after birth.” In clinical studies, the doula’s presence has been shown to reduce a mother’s desire for pain medication and need for low-level medical interventions while labor tends to be shorter with fewer complications.
Janet Hall Padgett, CD, CCE, founder and president of Birth Partners, LLC, attributes part of the increased interest in doula and midwifery services to the popularity of Ricki Lake and Abby Epstein’s The Business of Being Born documentaries. In her 24 years of experience, Padgett found that the recent films enabled more mainstream women and partners to envision what they can do differently for their birth experience. The Fairfield County-based Birth Partners provides pregnancy, birth and postpartum doula services as well as childbirth, breastfeeding and newborn care education classes.
As expectant parents increasingly choose to use doulas, Padgett stresses the need to ensure that the provider is certified. She provides even further training to her students beyond the general national certification requirements and attributes her company’s success to the high standard of doula training, service and professionalism she adheres to. “We have worked with every doctor, midwife and almost every nurse in the state. Twenty years ago was probably when we last had opposition, but I attribute that to the fact that we treat the medical staff as professionals rather than an ‘enemy.’ The client chose that provider and we need to respect that,” states Padgett. Even with the increased public knowledge, she does encounter misconceptions that doulas will take over for the partner and have strong biases about medicated births and doctors. “These are legitimate concerns, but a good, well-trained doula is none of those things. She is there to be a support system for the mother-to-be and her partner and not to change policies or protocol,” Padgett continues.
HypnoBirthing of Connecticut, based in Westport, is also focused on providing that necessary support. “How a women feels emotionally during her birth is a key part in how that labor progresses, dictating which hormones are released. Instead of the emphasis being on fear, the core of hypnobirthing is about tapping into that innate intuition that we have for giving birth,” explains Cynthia Overgard, MBA, HBCT, owner of the prenatal education center. “In our society, childbirth is viewed as dramatic or traumatic, causing us to spend all this time fearing and dreading it.”
Overgard utilizes a three-fold approach to collaboratively educating expectant parents. She focuses on birth information and enabling them to see that they are in charge of their health and experience. Learning to take control of their mind, body, breath and focus – similar to yoga practices – is part of the empowerment stage. Believing and seeing it is possible to have a normal, safe, calm and joyful birth can help inspire a more positive birth experience. In addition to the HypnoBirthing childbirth course, HypnoBirthing of Connecticut offers birth doula services and midwife-instructed birth preparation classes and breastfeeding workshops.
Ariana Rawls Fine is Assistant Editor of Natural Awakenings Fairfield County. She resides in Stratford with her family.
HypnoBirthing of Connecticut
420 Post Rd West, Westport