My Experience with Different Types of Midwives

Although there are certainly many articles on the internet explaining the practice of midwifery and different types of midwives, I wanted to contribute my own experience on the subject.

The two types of midwives available in my area, in California, are direct entry midwives and certified nurse midwives, or CNMs. When I was pregnant, I started out with a CNM at a birth center, but later switched to a direct entry midwife. Here’s what I learned through the process.

CNMs are certified as nurses, as their title may suggest. They are commonly found in hospitals and birthing centers. Direct entry midwives have birth training adequate to be certified by a governing board such as the North American Registry of Midwives or the American Midwifery Certification Board, and may have the title of CPM (certified professional midwife) or CM (certified midwife)—these types of midwives most commonly attend home-births or births in a birthing center.

Certified Nurse Midwives

Originally, I chose to use a birthing center which employed several certified nurse midwives. I found the birthing center to be a very appealing environment, and I felt more secure using a midwife who was also a certified nurse. Birthing at the birth center seemed like a safer way to have a natural birth.

I quickly found that I was not assigned to one particular midwife, but would get whoever happened to be there during my appointment. This may be unique to the particular birthing center I chose, but I did feel that my care was less personalized as a result—undermining one of the main benefits of midwifery as opposed to seeing an OBGYN. Ironically, most people seeing an OBGYN would at least have the benefit of receiving care from a single doctor, rather than a rotating set of doctors, thus giving them more personalized care than I was receiving at that birth center.

I also discovered that my care was very managed at the birth center. There were protocols, procedures, and rules that I was simply told to follow, without a great deal of input of my own preferences or thoughts. This is apparently the usual operating procedure for CNMs. I was told to submit to a pelvic exam during one appointment—not asked, but told. Another time, I was told to submit to a blood draw for blood tests. Neither of those procedures was offered to me for consideration, they were just an expected part of the process, and I was not given an option to decline. I found that this undermined another of the main benefits of midwifery, which is the right to be involved and in control of one’s own prenatal care.

The final straw for me with the CNMs at the birth center was when I was told to make my appointment for the gestational diabetes test. After carefully researching the subject, I found that I have an extremely low risk of gestational diabetes. I had not a single risk factor, other than being pregnant. As such, I spoke to one of the midwives about declining this test, and she agreed that it would be fine. Later, I received a call from the birth center again requesting for me to make my appointment, and when I explained that I would be declining, they put me on hold. A few minutes later, they came back and told me that it wasn’t allowed. I was flabbergasted to hear that I apparently wasn’t allowed to make my own health care choices, but I remained calm as I explained that I already received approval from one of the midwives. I was told that they would get back to me on the matter. A few days later, I received another call from the birth center. They told me that they had discussed my case in their staff meeting, and decided that I would not be allowed to decline the test. I told them I would be finding a new midwife.

At this point, I started to really look into all of the available midwives in my area, rather than only looking for CNMs, which there were only a couple of. That was when I finally came around to the idea of seeing a direct entry midwife, and discovered many benefits to this choice.

Direct Entry Midwives

First of all, with a direct entry midwife I was able to have a home birth without paying any extra fee as I would have had to for the birth center I was at before. I discovered that midwives bring all of the same equipment to a home birth as would be available at a birth center, making it just as safe of a choice. Not only that, but a home birth allows the family to be in a familiar and comfortable environment, and eliminates the need to do anything after the birth other than settle in with the new baby. That being said, direct entry midwives often work at birthing centers as well (my midwife has her own birthing center), and offer that as an option.

Second of all, I was able to choose the one person who would take care of my prenatal needs, and build a relationship of trust and comfortability with that person. There was no shuffling around with a different midwife every month.

Third, I was able to make my own health choices and wasn’t pressured to submit to any procedure. Everything was my choice, and everything was presented as an option, as it should be. I chose to decline certain procedures, such as the gestational diabetes screening, while accepting other procedures such as screening for GBS (Group B Strep). None of my choices felt judged by my midwife. I also was never even offered a pelvic exam until the birthing time, which is good because pelvic exams during pregnancy are not evidence-based or beneficial, and may in fact be harmful (not to mention uncomfortable).

Ultimately, I was very happy with my choice and I highly recommend direct entry midwives as an option for pregnancy and birth care. Not only did I have a much better experience, but I paid less for it, and it was much more convenient to have a midwife who was located closer to me and able to attend my home birth. My midwife happens to see clients at her birth center, but also offers a home-visit option, and many direct entry midwives offer home-visits only. Either way, using a CM or CPM is a wonderful way to receive excellent, personalized, and empowering care during pregnancy and birth. As for CNM care, I can only say that my experience was very negative, but others may find that this type of midwife suits them. Ultimately, the decision should be made with an open, yet discerning, mind.

Benefits of Natural Birth

Natural birth means different things in different contexts. Sometimes, natural birth refers to vaginal birth, as opposed to surgical birth via cesarean section. Other times, it refers to a vaginal birth without the use of medications for augmentation or anesthetic purposes (for speeding up the birth process or numbing pain). And of course, when some people hear the words “natural birth,” they picture a woman squatting in a field to give birth.

In the context of this post, natural birth means vaginal birth without the use of medications, regardless of the other details; a natural birth can happen at home, in a hospital, in a birthing center, and with the assistance of a doctor or midwife, or even unassisted (which is never recommended as a plan, but it can happen sometimes). Natural birthing can also happen in many positions; squatting is common, since it’s usually an anatomically optimal position, but other options are the well-known lying back position, kneeling, on hands and knees, side-lying, and so on. Some natural births take place in a tub of water, which can have added benefits.

So why would a woman choose a natural birth?

In our society, natural birth has become uncommon, although it is beginning to make a comeback. Yet still, many women who choose natural birth are labeled as martyrs, crazy, brave, odd, foolish, or many other words both positive and negative—but honestly, mostly negative. Some people may not understand why a woman would choose a birth involving pain when there are modern options that make birth much “easier” for the mother.

There are a number of reasons to choose a natural birth.

  1. A medical birth often involves unnecessary interventions that aren’t best for the mother or baby. One common example is birth that has “failed to progress,” and is pushed along using a medicine known as Pitocin. The reality is that birthing can take quite a bit of time, and most women’s bodies are capable of birthing at the right pace for themselves. Unless the baby is truly in distress, or the mother becomes too exhausted to continue, it is usually best to allow birthing to progress on its own. Another example is episiotomy, the cutting of perineal tissue instead of allowing it to stretch or tear naturally. While episiotomies may speed birth along, the tissue will actually heal better if allowed to tear; more importantly, allowing the perineum to stretch gradually may prevent tearing altogether, even though it takes longer than cutting. These are just two examples of how medical intervention during birth is often unnecessary and harmful.
  2. There are risks to the medications used in birthing. Using Pitocin to speed up the birthing process can cause more intense contractions, which are more difficult and exhausting for the mother, as well as more stressful for the baby. This can often lead to the use of pain medication in a birth that would have otherwise proceeded naturally. Pain medications such as epidurals can then cause birth to slow down again or stall. Often, the result is an emergency c-section for a woman and baby who should not have needed it. These medications have other risks and harmful side effects as well.
  3. Vaginal births are almost always safer than elective cesarean sections—even vaginal births after a previous c-section. One common thing to hear in the birth world is that women who have had a cesarean section must always have them for births afterwards. While there are cases in which that is true, in the vast majority of women, there is no need to automatically plan a c-section because vaginal birth still has fewer risks. Another common example of unnecessary c-sections are in the cases involving nuchal cords, or an umbilical cord wrapped around the baby’s neck. This is a relatively common occurrence, and does not constitute an emergency in most cases; babies in the womb breath through their umbilical cords, not their throats, and oxygen continues to flow through the cord even when it is wrapped around the neck or tied in a knot. C-sections are frequently done unnecessarily using the excuse of a cord wrapped around the neck. Surgical birth is very safe nowadays, and invaluable in situations where it is truly necessary—but for women who are able to safely give birth vaginally, c-sections are simply not the safest choice for the mother or baby. There are risks to any surgery, and this is a major surgery. It also involves a more difficult and longer recovery than a vaginal birth.
  4. Natural birth is the only option for birthing outside of the hospital. For some women, the scariest part of childbirth is the idea of going to the hospital to give birth and feeling vulnerable or out of control because of the hospital environment. Hospitals can make people feel like they are not in charge of their own bodies, or their own medical decisions. They can feel pressured to follow a doctor’s orders or a hospital’s policies, even when they aren’t comfortable with those choices. On the contrast, a birth in the comfort of one’s own home or in the home-like atmosphere of a birthing center can be a much more comfortable and positive experience. These environments are a great place for women to give birth with the assistance of a midwife or even in some cases a doctor, as long as they do not want or need special equipment or medications for their births. And of course, in the event of a change of plans or even an emergency, the hospital is always there.
  5. Natural birth allows the mother to be fully present and experience the birth process. Medications may cause mental fogginess, but a natural birth allows a woman to feel in charge of the process. Birthing naturally also brings a great sense of empowerment, and can boost the strength of the mother-infant bond from the start because it encourages skin-to-skin contact immediately following birth, and supports a strong start to breastfeeding for those who so choose.
  6. Natural birth does not have to involve pain. While many natural births do involve pain, there is another option. Hypnosis for childbirth is a powerful tool that works, allowing women to experience the intense sensations of birth as pressure or discomfort, without being overwhelmed by pain. Using hypnosis to prepare for a natural birth can also help the body to experience an easier, safer, and more peaceful birth process.

For me, the realization that I could have a natural birth at home was the reason I first was able to shed my fear and begin to feel confident about the birth process. When I discovered Hypnobabies, I became even more confident and excited. I used it, and it worked, and I can’t wait to do it again with my next baby. Childbirth can be a beautiful and positive experience—and that’s why I believe in natural birth, and especially in Hypnobabies.

What is Hypnosis?

For many people, when they hear the word “hypnosis,” they might imagine someone similar to a magician inducing a strange and mysterious trance on a subject, who they can then make perform embarrassing and comical behaviors. In reality, that image is an exaggerated description of stage hypnosis—which is an entirely different subject, really, than therapeutic hypnosis. Although stage hypnosis is based in the same concepts as hypnotherapy, it is used differently and for different purposes. Hypnosis used for therapeutic reasons doesn’t look or feel like a mystical phenomenon for most people—and that’s because hypnosis is really just a deep level of relaxation which allows for access to the subconscious mind. It’s actually measurable by changes in brain activity; in other words, it’s a real mental and physiological state, rather than an unexplained or strange phenomenon.

Another interesting thing about hypnosis is that it’s a state of consciousness that we experience many times a day, without even knowing it. When we watch TV, read, daydream, or start to fall asleep at night, those are all examples of times when we are in a state of hypnosis. So there’s really nothing weird or scary about it—it’s a natural state to be in. Another myth about hypnosis is that the client is under the control or power of the hypnotist. In truth, all hypnosis is self-hypnosis because the client always has the choice to ignore what the hypnotist says. The hypnotist is a guide who can say the right words, but it is up to the client to choose to accept them and follow the instructions.

In hypnotherapy, a practitioner will guide a client into a state of hypnosis and then make suggestions to the subconscious mind. Upon returning to a fully awakened state, the client’s conscious mind will begin to accept the suggestions as true, and those suggestions become beliefs which can profoundly shape that person’s experiences. The reason for this can be demonstrated through the placebo effect. The placebo effect is a proven phenomenon in which a person is given a medicine and told that it will cause a certain effect. That person then experiences that effect, based on what they were told the medicine was supposed to do. In reality, the medicine is just a “sugar pill” or a placebo, meaning it’s not a real medicine; but the effects that the person experienced were real, and they happened solely due to the belief that they should happen. This effect is an example of the power of imagination and belief.

Another example is when you are told that something is going to hurt, and it does—yet when the same action is done to you without that negative warning, or with an affirmation that it won’t hurt, it often doesn’t. When we expect pain, we often experience it. That’s not to say that pain is all in the mind, of course—yet, through hypnosis, it has been demonstrated that pain can be eliminated by the power of the mind. Hypnosis has even been used to successfully produce anesthesia in surgery, without the use of drugs.

Hypnosis for childbirth uses this same principle. We train our minds to believe in our ability to birth naturally, easily, safely, and without pain; and we do just that. It really works, and it’s not magic. It’s the power of our minds.

Mindfulness

This is my first official post on my new Mindful Birthing website. How exciting! I created this website as a home base for my new business as a Hypnobabies instructor and Hypno-doula, which I will be starting in mid 2017 after my training is complete. I also hope to use this space as a blog to share my thoughts on the topics of pregnancy, childbirth, and parenting. I’ve decided on the name Mindful Birthing because it embodies what I feel is most important in the birth process; being mindful.

Mindful birthing means many things to me. It means carefully considering options throughout the pregnancy and birth process. It means examining your own thoughts and training your mind in a positive way, to achieve the best possible outcomes. It means being present and at peace with the process as a whole.

The mind is a powerful tool to create tangible effects in the body. This is a scientifically studied and proven phenomenon which is the basis for hypnotherapy, and the reason that hypnosis works for improving the experience of pregnancy and birth. This is the beauty of mindfulness; harnessing the power of one’s mind for positive results.

I am so excited for what the future holds as I follow my dreams and start my own business, sharing this power with others and making the world a better place, one pregnancy and birth at a time.