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May 1, 2013 / amiller1012

Difference in types of midwives

Midwives exist in all parts of the world. In Sweden, they provide more than 80 percent of prenatal care. In Austria, the law requires that they be present at every birth. In the UK, they attend nearly 70 percent of all births. Even developing countries rely on midwives for childbirth.

The International Confederation of Midwives describes a midwife as a person who has an “important task in health counseling and education, not only for the woman, but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and childcare.”

There are several types of midwives: lay, certified, certified nurse, certified professional, direct-entry, and licensed. The differences between these qualifications are typically the level of education and amount of training.

Lay midwives are uncertified or unlicensed. They are usually self-taught or have learned through apprenticeship rather than formal education. It’s important to note that this term does not mean she has a low level of education, but rather chose not to receive certification or there was no certification for her type of education.

Similarly, an independent practitioner educated in the discipline of midwifery through self-study or apprenticeship is a direct entry-midwife. They, however, have met the standards of certification set by NARM, the North American Registry of Midwives.

Certified midwives are educated in midwifery and possess evidence of certification through the American College of Nurse-Midwives (ACNM).

Certified nurse-midwives have the same qualifications, but have also acquired a bachelor’s degree and are educated in the study of nursing.

A certified professional midwife meets the standards for certifications set by NARM and is qualified to provide midwifery care. It is the only international credential that requires knowledge of and experience with out-of-hospital settings.

A midwife licensed to practice in a particular state or province (or other jurisdiction) is a licensed midwife. They consult other health professionals for patient care issues outside of the area of expertise.

May 1, 2013 / amiller1012

Natural and home birth trends

In the late 19th and early 20th centuries, almost all births took place outside of a hospital, most of which were in the home. By 1940, the number had dropped to less than 50 percent and by 1969, had diminished to nearly one percent.

There are several developments that occurred after World War II that are believed to have influenced this decline. Medical education opportunities increased, resulting in nearly double the number of medical schools and physicians.

The Hill Burton Act increased access to hospital care and hospitals then began offering pain relief methods that were not available outside of a hospital setting. Many women were drawn to lower pain levels over the natural birthing experience.

However, one of the largest influences was the establishment of employer-based health insurance and the creation of Medicaid. It provided insurance for most pregnant women, but only in the care of doctors and hospitals, not midwives.

While home births are still rare in the United States, less than one percent of births, the numbers have continued to grow since 2004. This does not include births in a birthing center.

The percentage of births outside of a hospital setting is difficult to further categorize (home, birthing center, other specified locations) because it was not thoroughly distinguished before 1989.

Many women are beginning to return to the natural birthing process, both inside and outside of the hospital setting. Hospitals do not expect a woman to endure the pain of labor or expect a laboring woman to control her contractions.

Emily McClements describes her natural birthing experience within a hospital setting and offers advice for other expectant mothers with the same desires. Click here for her story.

May 1, 2013 / amiller1012

Birth center empowers women

Inanna Birth and Women’s Center in Denton has been empowering women and their families through the natural birthing process since 2006. Jean Smith, a certified nurse-midwife (CNM), purchased the property and opened the center after practicing nursing for over 10 years in labor and delivery.

For the first year, Smith was in charge of the clinical aspect while her then-business partner oversaw the financial aspects. She had an assistant who helped as needed, but the workload was far too heavy.

Smith brought on her good friend and fellow CNM, Betty Hoffman, to provide much needed relief. She also had a part-time CNM who worked on Thursdays. Smith says the best part was knowing that “at least on Thursdays [she] could finally get some sleep”.

The rewards, she says, outweigh the stress. Her favorite part about being a midwife is watching women discover their strength. Often she gets women who claim to have a low pain threshold and fear that they will need pain medication.

Many of the women who have their first natural birthing experience with Smith surprise themselves with what they are capable of. Smith recalls one patient that truly reminds her of the power of a mother.

The woman was a pilot with severe anxiety and would often pass out, causing her to have to leave her job. During labor, the women repeatedly said, “I’m going to faint.”

Smith looked at her and, in a stern voice, said, “No, you are not. It’s physically impossible for you to pass out when you’re lying down. Now you’ve got to suck it up, girlfriend, and tough it out.”

She went from a timid, self-conscious woman to a “powerhouse”. It’s life-transformations like these that keep Smith pushing through when the center gets busy.

The center delivers about 15 babies each month. It provides care and monitoring during the pregnancy, care during labor, and checkups for the mother and child through the postpartum stage.