To Take the Class or Not…That’s the Question…

childbirth ed

Childbirth education classes.  Are they all they’re cracked up to be?  Are they really that important, necessary, worth your time?

It’s been a little bit since I’ve posted in my pregnancy series.  In keeping with the sequencing of preparing for baby, it seemed the next logical post should address the idea of childbirth education classes and their importance to pregnant mamas.  Let me just start out by saying that whether you’re planning, or hoping for, a natural delivery or medicated, vaginal birth or cesarean section, childbirth education classes are a MUST in my opinion.  The ultimate goal is for mamas (and dads) to have the confidence to make their own choices and decisions during the childbirth experience.  This confidence comes directly from educating oneself and being fully prepared for what is about to occur during that beautiful time.  Childbirth education classes don’t just educate; they can relieve stress and anxiety by explaining the ins and outs of labor, inform mamas of their options, teach relaxation, breathing and pain relieving techniques, create and foster a bond between mom and dad in preparation for baby’s arrival, inform dad about the process, support he can give and his role in the birth of his child and prepare new mamas for what lies ahead.

“Taking a course is not a requirement; you’ll get to give birth no matter what,” says Heidi Murkoff, author of What to Expect When You’re Expecting (Workman Publishing). “It’s just that they call it ‘childbirth preparation’ for a reason: it helps prepare you. It takes the mystery out of it. Information is empowering, and what you don’t know can scare you more than it should.”

Although most doctors, midwives and doulas across the country recommend their patients take some sort of childbirth education/preparation class, more and more women are choosing to forgo taking the class in exchange for doing their own research on the internet (which might explain why you’re reading this post in the first place! ;)).  According to a study by Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences (Declercq, Sakala, Corry, & Applebaum, 2006), researchers found that only about 56% of women expecting their first baby took a childbirth prep class and 9% of experienced mamas took a class.  However, 82% of women included in the study claimed to have wanted more information about the birth process.  These statistics are startlingly alarming for maternity doctors, nurses, midwives and doulas.  Basically what it means is that although women admit to needing/desiring to be better informed, they are not following through with taking the classes that can give them this knowledge.  This leads to women in the delivery room who are not prepared, have no information on breathing or relaxation techniques (think this might have something to do the fact that 81% of first time moms have an epidural!?) and who have to rely whole-heartedly on their provider for advice and what to do.  Not only does this cause more work for the provider, but it also creates an experience where the mama is unable to take charge of her birth and make informed decisions on behalf of herself and her baby where she is in control.

Benefits of Childbirth Education Classes

  • Build mama’s (and dad’s) confidence in herself and her ability to give birth
  • Educate on the process of labor including stages, what to expect, duration of each stage, etc.
  • Inform mama on signs of labor, when to call your caregiver/go to the hospital or birthing center, what to do if your water breaks, how to time contractions, false labor vs the real deal
  • Give parents the ability to discuss and dispel fears and concerns not only with the childbirth educator, but also with other couples with similar concerns
  • Educate on pain management techniques including breathing, relaxation, massage, aromatherapy and pain medicine options.
  • Not only teach about breathing techniques, but also give mamas an opportunity to practice these techniques ahead of time so that she feels more prepared for labor
  • Inform dads (or birth partners) on support to give laboring mamas, what to expect and what role to take in the childbirth process (things to do, get, be in charge of, etc.)
  • Build a community of support by getting to know other couples in your class that are going through the same thing you are
  • Inform mamas of what to expect before, during and after labor, both physically and emotionally.  Including recovery information and tips.
  • Educate new parents about care of newborns – safety, feeding, diapering, overall care, how to identify illness, how to deal with fussiness, etc.
  • Give parents an opportunity to tour their birthing facility (if classes are taken at the same location) – this reduces anxiety, gets you familiar with the surroundings and eases tension when labor actually starts because you’ll know exactly where to go!

“Prepared childbirth classes remain a valuable experience for individuals who participated. In the present study, the majority of women who attended classes viewed childbirth educators and prepared childbirth classes positively. Women who attended classes were more satisfied with their labor and birth experience and felt more prepared compared to women who did not attend classes” – “Patient’s Perspectives on the Role of Prepared Childbirth Education in Decision”, Lamaze Institute

Types of Childbirth Education Classes Offered

  • Lamaze® International: a contemporary curriculum that supports birth as normal, natural, and healthy and empowers expectant women and their partners to make informed decisions.  For more info: http://www.lamaze.org
  • The Bradley Method®: helps women prepare for a natural labor and birth without the use of medication or medical interventions.  For more info: http://www.bradleybirth.com/
  • Hypnobirthing®: teaches mothers that if you remove fear and tension, severe pain does not have to be part of labor. Intense relaxation will enhance natural birthing instincts that lead to a calm and serene birth experience.  For more info: http://www.hypnobirthing.com/
  • Birthing From Within®: prepares mothers to give “birth-in-awareness,” not to achieve a specific birth outcome.  For more info: http://www.birthingfromwithin.com/

Where Do I Find a Childbirth Education Class?

Or talk to:

  • Your caregiver – doctor, midwife or doula
  • Your birth facility – hospital or birthing center
  • Friends and family
  • Community resource centers

So there you have it.  Some of the ways that educating yourself ahead of time through childbirth education classes can help before, during and after your childbirth experience.  Can you find some of this same information on the internet??  Probably, and in fact people like me would be without readers if no one used the good ol’ World Wide Web to educate themselves.  However, there is something to be said about having that back and forth conversation and relationship while learning, the ability to ask questions and get expert advice, building and fostering relationships not only between you and your spouse/birth partner, but also among other couples preparing to take the same journey as you and the educator who is a certified expert in this content and obtaining hands-on skills and practice that can only be achieved through childbirth education classes.

I get it, you’re thinking that all that breathing crap is hooey when it comes time for labor and yeah, yeah it will all go out the window when the pain gets tough… but I’m here to tell you that that isn’t always the case.  Take it from a girl who “breathed” her way through a natural childbirth.  Furthermore, don’t you suppose those breathing and relaxation techniques might come in handy later in life??  For example, when the baby has colic and won’t stop crying for hours, or when your toddler has pushed you to the limit??  Besides, these classes are about WAY more than just breathing (as we’ve already established)!  So if you haven’t done so already, do some research and get yourself signed up for a childbirth prep class.  Trust me, you won’t regret it…but if you don’t, when the going gets tough right around being dilated to 5-6…you’ll wish you had! 😉

“We could all use a little Lamaze in our life endeavors.  Between each push, remember to breathe.” -Unknown

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References:

American Pregnancy Association

Lamaze Institute, “Patient’s Perspectives on the Role of Prepared Childbirth Education in Decision”

Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences

 

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Wait… You Mean My Due Date is Just an Estimate?!

Everywhere you look in our society, whether it be on social media sites among our circles of friends or celebrities in the tabloids, women (and men for that matter) appear to be under some sort of screwed up notion that your due date is this magical day on the calendar when poof! your baby is ready to be born.  What they apparently fail to realize is that in fact this isn’t the case at all!

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M was born a week late.  I was teaching at the time and therefore only had 12 weeks of maternity leave to be at home with her.  Consequently I worked up until the day that she was born.  This meant 2 weeks (because people started asking/commenting a week BEFORE my due date..SERIOUSLY!?) of getting comments like: “What? Here again?” “No baby yet?” “How are you feeling, any signs yet?” “When are you going to get induced/how far past your due date will they let you go?” or my favorite, “You’re still here/still no baby?!”… YES I’M HERE, IF I WASN’T YOU WOULDN’T BE TALKING TO ME RIGHT NOW AND DO I STILL LOOK PREGNANT TO YOU, THAT MEANS NO, NO BABY!!  I hated it!  I mean I know that all of my coworkers at the time meant well, but it was seriously so annoying.  Just because I was nearing my “due date” didn’t mean that the baby would be born by that day!

So let’s set the story straight, due dates are simply an estimate.  In fact, most research states that a due date is typically within a 2-4 week window of when the baby will actually be ready to be born. According to the American Pregnancy Association, only 5% of babies are born on their actual due dates.  However, 80% of babies are born between weeks 37-42.  Due dates are typically determined based on the 1st day of the mama’s last menstrual cycle.  Providers assume that she has a typical 28 day cycle and ovulates half-way through on approximately day 14.  The problem with this method of determining one’s due date is that not all women are the same.  For me, for example, my due date with M was August 31st.  However, I got pregnant using an ovulation kit and therefore knew the exact date of conception (which was on day 21 by the way…).  When I calculated my due date on my own using the date of conception, I came up with September 4th… not so far off from her September 6th birthday.  Given this and the fact that she was born supposedly a week late weighing just a little over 7 lbs, I’m incline to believe the estimate of my due date was just a little off.

My mom has a similar story with me.  I was due August 1st and was born August 17th (over 2 weeks late supposedly) and yet I only weighed slightly over 7 lbs as well.  Kinda small for a baby 2 weeks late, huh?!  Then again since due dates are only an estimate made based on a generic formula that’s supposed to fit all women, maybe I wasn’t actually late after all!

Some people think that their ultrasounds have all the answers and can give them a more accurate due date.  Well I’m sorry to break it to you, but that thinking is wrong as well!  Prior to 18-20 weeks of pregnancy, ultrasounds have a margin of error of roughly a week and a half of predicting accurate due dates.  Between 18-28 weeks, this margin of error jumps to slightly over 2 weeks and by 28 weeks of pregnancy, ultrasound due dates can be off by over 3 weeks!!!  Apparently ultrasounds only give you an estimate as well!  Are you noticing a trend here… let me spell it out for you, your due date is a ESTIMATE!  (Let’s face it, there’s only 1 person who really knows when your baby is going to be born and it would do you good to remember it should be all on His time!)

So, why do I get so fired up about people’s over-reaction to their impending and heaven forbid passing of their due dates?!  First off because I was one of those women.  The one who had her baby past her due date and therefore had to be subject to all the annoying, unending questions.  And second (and more importantly) because of the number of women having elective inductions based on an “overdue” baby.  What happens when that 40+ week baby is actually only 38 or even 37 weeks along and isn’t ready to be born yet….. ahhh… now we’re getting somewhere.  But, that’s a post for another day… stay tuned! 😉

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Where to Deliver: The Hospital, Home birth, Birthing Center Debate

In 1900, almost all births occurred at home.  Women had their babies in their homes, in their own bed, with the assistance of family, friends and local/community midwives.  By the 1940’s the home birth rate dropped to 44% and continued to decline to around 1% by 1970.  From that time period until the early 1990’s, around or slightly under 1% of births occurred at home.  However, since 2004, home birth rates have increased 29% and continue to rise.  Women today are now able to consider the option of home birth once again as a safe alternative to hospital care – depending on their pregnancy.

Everyone knows that babies can – and sometimes should – be born in a hospital setting.  However, it is important for women to weigh their options and educate themselves on other birth locations should they be interested.  In addition to home and the hospital, many women find birthing centers to be a nice compromise.  Prior to making any pregnancy related decision, the best thing a woman can do it weigh her options, keeping her pregnancy and health in mind at all times.

Hospital delivery:

Pros – Surrounded by medical interventions/technology in case of an emergency, nursing staff tends to the needs of mom/baby, nursery care available to allow mom time to rest, trained professionals to deal with complications, variety of resources available (pediatrician, lactation consultant, family counselor, etc.), care covered by insurance

Cons – Higher chance of complications due to medical interventions, higher risk of cesarean section, some hospitals have policies/protocols that you have to follow (ex. automatic IV insertion upon admission, 24 hour labor maximum after water breaks, Pitocin or other interventions if labor “stalls”), several medical personnel in and out of the room during and after labor/childbirth

Birth Center delivery:

Pros – Prenatal appointments, labor and childbirth, and postpartum care takes place all at the same place – creates a sense of comfort and familiarity, private suite typically with kitchen and living room accommodations for family members, commonly under the care of a midwife resulting in a more personal, supportive experience, trained professionals to deal with complications, encouragement to have a more natural childbirth experience, lower costs, less time away from home, quiet experience with few medical personnel – typically just the woman’s midwife and doula are present, some medical interventions available

Cons – Pediatricians aren’t on location, in an emergency situation the woman would have to be transported to the nearest hospital, sometimes insurance doesn’t cover birthing center deliveries, less medical technology in the event of complications, no nursery to send baby to

Home delivery:

Pros – Much more calm, comfortable and relaxed environment, natural experience, no one there other than family, friends and midwife/doula, immediately after delivery the mom and baby are back to “normal” at home, freedom to choose everything about labor/childbirth process

Cons – Can be far from hospital in the event of an emergency, can be unprepared to handle some complications, often insurance doesn’t cover home births, no medical staff present other than midwife/doula (ex. no pediatricians, surgeons, nursing staff, etc.)

 

While a home birth might sound like a good fit for you, if you have anything at all that isn’t a “picture perfect”, normal pregnancy, being away from a hospital with potentially necessary medical interventions could be harmful to you and your baby.  At the same time, if you are low risk, live within a short distance to a medical center and desire an all natural experience, perhaps a home birth is indeed to best option for you.  Perhaps you’re torn between wanting the safety of having medical professionals nearby “just in case” and wanting a quiet, relaxing, natural environment, then a birthing center may be just right for you!  Take some time to think about it, do your research and make a choice to suit you.  As I’ve said before, the most important thing to keep in mind when considering where to deliver your baby is what YOU want and what is safest/the best option for your pregnancy.

Stay tuned for the next segment in my pregnancy series… it’s a hot, controversial topic that is being talked about more and more: VBACs.  What are the risks, myths, and facts surrounding vaginal births after cesareans?

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I’d love to hear about your experiences, whether your baby was born in a hospital, birthing center or at home.  Where did you choose to have your baby and were you happy with your choice?  Let me know below!  As always, if you have any questions – I’d love to answer them for you! 🙂

 

 

http://www.cdc.gov/nchs/data/databriefs/db84.pdf

http://www.babycenter.com/0_birth-centers-alternatives-to-hospitals_2007.bc

What is a Doula?

Now that we’ve established the differences between a Midwife and an OB (You’re pregnant, huh? Now what? Let’s talk: Midwives vs OB), it’s time to think about whether or not a Doula is for you.  Perhaps you’re sitting there wondering what exactly a Doula is/does.

According to DONA International – DONA stands for Doulas of North America – “the word “doula” comes from the ancient Greek meaning “a woman who serves” and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.”

Stated simply, a Doula is someone present just before and all throughout the labor and childbirth experience.  She provides guidance and support to the mother, as well as acts as an advocate for the mom if necessary.

What is a Doula?

  • A trained professional with a deep understanding of the labor and childbirth process
  • Someone who will be at the mom’s side for the entire duration of labor
  • Provides hands on treatment for pain management such as massage, pressure points, position changes, breathing techniques etc.
  • Helps the mom through the stages of labor and is able to encourage her through the process and in according to the mom’s wishes/birth plan
  • Can help the mom gain a better understanding of medical interventions offered during labor and the benefits/negative effects of them on her and the baby
  • Can ease anxiety associated with the unknown of labor by giving a thorough explanation of what’s happening
  • Helps to process information and talk through potential scenarios associated with emergencies/complications that might arise

What isn’t a Doula?

  • A medical professional
  • Someone who will administer medical interventions – epidural, pitocin, etc.
  • The person who “delivers” the baby – in fact, to quote “The Business of Being Born”, doula’s don’t deliver babies, midwives and doctors don’t deliver babies, mom’s don’t even deliver babies.  Pizzas are delivered.  Babies are birthed. 🙂

Benefits of a Doula – If you desire a natural childbirth experience, studies have shown that having a doula can reduce your chance of having a cesarean section by 50%, the length of your labor by 25%, and the chance of you asking for an epidural by 60%.

Things to Consider

  • Even if you have a Doula, your husband or significant other can still be a huge part of your labor process.  Doulas will be as involved or uninvolved as you want.  They can also provide as a support to your spouse.
  • If you are choosing to have a natural childbirth experience, it’s possible that you will forget about your birth plan as labor progresses and the pain becomes more intense. Doulas can help you stay the course of your birth plan, helping you to be more satisfied with your outcome.
  • Doulas often advocate on behalf of the mother to medical staff regarding undesired interventions, combining the wishes of the mother with an understanding of labor/options from a medical perspective.
  • Typically mothers meet with their Doula in the weeks preceding labor to begin developing a relationship so that the level of comfort is present by the time labor occurs.
  • Costs involved with hiring a Doula can vary greatly.  In some hospitals there are volunteer Doulas available at not cost to the mother – however this is essentially a stranger because they meet each other when the mom comes into the hospital already in labor.  On average though, Doulas cost anywhere from $400-$1,000 depending on their experience, where you live, etc.

Hopefully now that you have a little more information on Doulas you feel a slightly more confident to make the choice as to whether or not a Doula is for you.  Although I chose not to have a Doula present for my childbirth experience due to a variety of factors, I appreciate the value in them and am even working towards becoming Doula certified myself.  As with everything pregnancy related, the most important thing you can do is become well educated and make a choice that best suits you and your pregnancy!  Stay tuned for my next post: Where to Deliver?

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For more information, check out the following websites:

DONA International

Childbirth and Postpartum Professional Association

International Childbirth Education Association

Did you chose to have a Doula present for your childbirth experience?  I would love to hear about it and what you thought!!  Do you want to know more or have specific things you’re curious about?

Comment below with your experiences or if you have questions regarding Doulas!

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http://www.dona.org/mothers/index.php

http://www.dona.org/mothers/why_use_a_doula.php

http://americanpregnancy.org/labornbirth/havingadoula.html

http://www.cappa.net/get-certified.php?labor-doula#jobs

http://www.childbirth.org/faq.html

http://www.doula.com

http://www.icea.org

http://www.thebusinessofbeingborn.com

You’re pregnant, huh? Now what? Let’s talk: Midwives vs OB

So, you saw a double line, plus sign or maybe one little word that changed everything.  Pregnant.  Let me be the first to say CONGRATULATIONS!  You are about to embark on the most important, scary, hard, yet oh so exciting and amazing journey of your life.  While pregnancy can evoke lots of different emotions, sometimes all at the same time, I remember the one always at the front of my mind was awe.  I mean seriously, you’re growing a child inside of you.  A real person!  Wowza!

Over the next several weeks I will be posting a series of entries highlighting some of the more important and perhaps controversial topics associated with being pregnant.  My goal is to share my thoughts, have conversations with some of you and provide some food for thought for others of you who are looking for answers.  I’ll be working my way through pregnancy to labor and finally the birth of your beautiful baby – starting with first things first.  You’re pregnant…now what?  What are your options and how do you go about choosing a provider for your care during the most important 9 months of your life?

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“Wait, what?  You go to a midwife??? (insert shocked face) Why???”

“You see a midwife?  So does that mean you’re planning on having your baby at home?”

“What’s a midwife?  Like back in the old days?”

“A midwife?  So everything has to be all natural?  Do you actually think you can do that?”

No joke, these were some of the things I was asked on a regular basis after telling people that I was seeing a midwife for my prenatal care back when I was pregnant with our daughter.  While I can’t say that the lack of true understanding of what a midwife is was surprising (given the fact that although midwifery is on the incline it still isn’t widely used in the United States) I was somewhat shocked by the stereotypes that still accompany the term ‘midwife’.

I have always been someone who favors the more natural approach in my life.  I don’t take a lot of medicine, limit the toxins going into my body and look for more natural remedies to use in my home.  For as long as I can remember I have also been someone interested in (okay probably more like obsessed with) pregnancy and childbirth.  Before I was even married I read book after book about pregnancy, particularly natural choices in pregnancy, therefore when I did get pregnant I knew right away that I would be seeing a midwife as opposed to a regular OB.  Luckily for me, there is a group of midwives associated with one of the hospitals nearby – they deliver at the hospital, insurance fully covers their services and they work closely with an OB should something go wrong – so my choice was easy.  Maybe you, however, don’t have as much experience with midwives and therefore don’t even know what they really are.

Let’s talk facts…

  • There are several different types of midwives: Certified Midwife (educated in midwifery and certified based on the requirements of the American College of Nurse-Midwives, Certified Nurse Midwife (educated in midwifery and nursing and certified based on the requirements of the American College of Nurse-Midwives, Certified Professional Midwife (professional independent midwife certified by the North American Registry of Midwives – required to have knowledge of and experience in out-of-hospital settings), Direct-Entry Midwife (provide care in settings out-of-hospital, independent practitioner), and Traditional Midwife (usually referred to as community midwives, aren’t licensed or registered.)  FYI my midwives were CNM.
  • In the USA in 2011, Midwives attended 7.8% of all births
  • According to a research study conducted by Dr. Peter Schlenzka, in a review of over 800,000 births, there were no advantages of a standard obstetric hospital approach over a nurse-midwife setting inside or outside of the hospital
  • Use of the Midwives Model of Care has been shown to drastically reduce the presence of birth injuries, trauma and Cesarean sections.
  • Midwives provide much more personal, hands on care, working WITH the mother to ensure the best pregnancy, labor and delivery experience possible.
  • Childbirth being tended to by midwives have reduced infant and mother mortality rates.
  • Women who receive continuous care from midwives are less likely to have a baby before 37 weeks, or to lose their babies before 24 weeks.
  • Statistically, women who use a midwife are more satisfied with their care and have a more positive labor and childbirth experience.
  • Women under the care of a midwife see increased breastfeeding initiation and overall success

World Health Organization statistics show that births attended by midwives have lower infection rates, lower Cesarean section rates, fewer complications and healthier outcomes—thus, lower overall medical costs—than physician-attended hospital births.  -World Health Organization

How about some myths surrounding midwives…

  • A midwife only delivers babies at home – while some midwives deliver babies at home or in birthing centers, the majority of midwives in the United States deliver babies in a hospital setting.  In fact, statistics say that of the childbirths that take place under the care of a midwife, 95% occur in a hospital.
  • If you go to a midwife, you have to have your baby naturally with no epidural – statistically mother’s who are under the care of a midwife are less likely to have an epidural during labor, however it doesn’t mean that they can’t have one just because they’re seeing a midwife.  While midwives might encourage a more natural approach, they ultimately strive to empower the mother to take control of her labor experience and what she desires, whether or not it is natural.  However, they are equipped with some great pain managing techniques – which will be discussed in a future post!
  • Midwives aren’t well trained/what happens in the event of an emergency? –  I chose to see a group of midwives who were all Certified Nurse Midwives and had gone through extensive training and certification through the American College of Nurse Midwives.  In addition, my midwives all have their Master’s in Science of Nursing degree.  Finally, they have an OB on staff that is able to step in at any point should the pregnancy or childbirth take a turn and become an emergency situation.  I felt that my midwives were highly educated and very well trained especially in the area of pregnancy and childbirth.  As someone who desired a natural childbirth experience, midwives were much better trained when it comes to pain management and staying away from unnecessary medical interventions.

Using an obstetrician may be a disadvantage if you desire a more natural, hands off approach to pregnancy and childbirth. Obstetricians are trained to manage complications using many medical interventions. Some possible disadvantages to using an OB/GYN include: Increased risk of an episiotomyinduction or assisted delivery, Increased chance of cesarean birth.  -American Pregnancy Association

When would it be appropriate/necessary for you to choose an Obstetrician (OB)?

  • If you already see an OB/GYN that you are comfortable with, have built a relationship with and who you feel would suit your desires and goals during your pregnancy and childbirth experience.  At the end of the day it’s all about what you want.  If you feel that your current OB is completely supportive of those desires – whether they’re to have a natural experience or not – then that’s great!
  • If you are high risk.  Women deemed high risk, whether due to age, health, multiples, etc. should see an OB/GYN.  Although midwives are trained to deal with complications as they arise, a regular OB has a deeper understanding of dealing with high risk situations and there’s a good chance that a midwife would refer you to one anyway.
  • If you want a painless labor and delivery, like the idea of being induced (please do your research first…more on this topic in a later post!) or are open to and hope for as many medical interventions as possible/as your OB deems “necessary”.  While you can still have an epidural with a midwife, inductions are not very likely and as a whole they will be very slow to introduce medical interventions during labor unless it is an emergency situation.

The bottom line…

While I know the prospect of choosing your pregnancy healthcare provider can seem slightly overwhelming, at the end of the day all that matters is what you as the mama wants.  The best thing that you can do for yourself and your baby is to educate yourself on your options and make a choice that will ensure you feel empowered to have the pregnancy, labor and childbirth experience that you desire.  My wish for you is that in addition to taking a little time to do some research, you might question the “norm” and think about what type of care is best for you and your baby.  Be sure to stay tuned for my next post on pregnancy: “What is a Doula?”

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PS – The following are great resources on midwifery care:

Midwives Alliance of North America

American Pregnancy Association

American College of Nurse-Midwives

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http://www.mana.org/about-midwives/what-is-a-midwife

http://www.midwife.org/Essential-Facts-about-Midwives

http://americanpregnancy.org/labornbirth/midwives.html

http://www.mana.org/about-midwives/midwifery-model

http://www.huffingtonpost.com/2013/08/20/midwifery-benefits_n_3787058.html

http://americanpregnancy.org/planningandpreparing/choosingob.html

https://www.multicare.org/file_viewer.php?id=8270‎