Welcome to the Dear Midwife, Frequently Asked Questions page. Below you'll find some common questions posted by our readers, and answers from Anne Sommers, Licensed Midwife.
If you have a question to ask, please go to Ask Anne page.
Q Why would I choose a midwife?
A For the quality and quantity of personal care that she gives.This not only includes her bedside manner, her being on call for you 24/7, but her holistic approach (mind, body, family, emotional, spiritual, dietary) to you and your baby. You would choose a midwife because she will spend more time with you than an OB who will average about 2 ½ hours total during a pregnancy, labor, birth and post partum period. A midwife will get to know you. She gives you counseling, recognition, time and TLC, designed to make your birth experience the healthiest and safest that it can be. Her care is woman-centered and family centered. She views your pregnancy and birth as a passage requiring support, a natural, normal event, not as a medical procedure.
You would choose a midwife because she is less likely to interfere with the natural process, something that medical personnel often do, thereby causing iatrogenic complications during the birth process. Midwifery care is a gentler, nicer, pleasant way to have a baby. Women are honored, not treated like a piece of meat or with assembly line procedures. And, since siblings, and relatives are encouraged to participate in the birth, midwifery care enhances the family unit
You would choose a midwife because home birth with a midwife is safe, mainly due to the one to one care you will receive and because a midwife thinks of you as a healthy person, not a patient. She knows that to have an effective labor that a mother must move around, change positions, not be confined to bed, and eat and drink in labor.
You would choose a midwife in contrast to a standard medicalized birth attendant and facility. Hospitals are known for their high tech apparatus. However, all the technology in the world won't help if the person caring for you isn't knowledgeable, reliable, or ignores you. In the hospital where technology is god, nurses can be disagreeable and overworked and may have many patients they have to attend to.
You have strangers caring for you. A large staff of people coming in and out of your labor and delivery room means less accountability and more chance of infection, and a larger room for error. What if they are not reading the machines/monitors? What if they are not interpreting them correctly? What if your body needs to move around in labor and you are prohibited from doing so? Furthermore, since nurses are more responsible for your care than your doctor and their shift changes every 12 hours you are not getting personalized care.
You would choose a midwife in order not to get assembly line procedures; most of which are unnecessary, counter productive and uncomfortable, such as IV’s, delivering flat on your back, routine episiotomies. Furthermore, your doctor who may participate in your labor via phone calls to the nurse, and spends the least amount of time at your birth may not be on call the day you go into labor. You may have a stranger deliver your baby. However, with a midwife, she will spend most of your labor with you in addition to her time at your prenatals and post partum. You will have a chance to meet all of her assistants. With a midwife, you will not have strangers caring for you.
Q What Equipment Do Midwives Bring to a Birth?
A Though individual midwifery practices are different throughout the country and whereas many midwives practice under politically harsh conditions, generally speaking your midwife should have these items available to her when she comes for your delivery.
- Doppler and a fetoscope
- Medication to control hemorrhage: Pitocin, Methergine (IM, oral)
- Oxygen tank(s) and gauge(s) with adult and pediatric masks, cannulas, tubing
- Suction devices, such as Delee traps
- Instruments: scissors, hemostats, needle holders, etc.
- Blood pressure cuff/stethoscope for an adult
- Ambu bags, adult and infant with a variety of sizes of infant masks
- Suturing equipment
- Catheterization equipment
- IV equipment
- Baby scale, tape measure
Extra items that a midwife may carry:
- Pulse oxometer
- Newborn blood pressure cuff
- Airways, infant and adult
- ET tubes 2.0-4.0
- Laryngoscopes: adult and infant
- Medications such as Vitamin K, eye ointment, lidocaine
- Tubes for the laboratory examination of cord blood
- Herbs for labor
- Miscellaneous items, such as a mirror, flashlight
- Extra birth supplies: sterile/non sterile gloves, Betadine, sterile and non sterile gauze pads, K-Y jelly, bulb syringe, cord clamps, alcohol pads,perineal oil, ammonia amps
Q My wife had two ultrasounds done and we still cannot tell the sex of our baby. The baby's heart rate has always been high. At the last two Dr. visits, the baby's heart rate was 139 and 146. I read some where that the child's sex can be determined by the heart rate. Is there any truth to this?
A I do not believe that anyone can tell the sex of a baby by the heartbeat. And though I do not know where this idea originated, the myth goes that a girl's heartbeat is higher than a boy's heartbeat, and closer to 160 beats per minute, while a boy's is 140 or under.
The normal heart rate for a baby (either sex) is between 120 and 160 beats per minute. The younger the fetus, generally the higher the heartbeat. Therefore, at 9 weeks of age, a fetus most likely will have a heart rate of 160. At 28 weeks 140. Also, when a baby is sleeping the heart rate falls.
Re: ultrasounds to detect the sex of the baby.Most ultrasound technicians think that the best time to visually see the baby’s genitalia is around 20-22 weeks.Also, there is a blood test that can determine the sex of the baby; as well as amniocentesis.
Q What if the umbilical cord is wrapped around the baby's neck?
A When the baby emerges from the birth canal, the midwife feels around the baby's neck for a cord. If a cord is present, she gently unloops it over the baby's head. If it is tight, she clamps and cuts the cord, while the baby is on the perineum. One in three babies are born with cord around the neck. It may be considered a complication, but not an emergency.
Q Does insurance cover midwifery care?
A Yes, most do in California, if you have maternity coverage on your policy.Nationwide Insurance I found, does not. The Midwifery Licensing Act originally mandated coverage for Licensed Midwives. But insurance companies, it seems, can get around it. Every state has its own laws and these rules can change every year.
Usually in order to get insurance reimbursement, a client must have a PPO. Some HMO’s will refer their client out to a midwife or allow a midwife to be contracted temporarily though the insurance’s network. The client needs to request this. This is done on an individual basis.
Q Am I putting my wife in danger if we choose to have a home birth?
A Husbands share a large responsibility for the safety of their wives; they love them and naturally want to protect their health and life. However, I never talk people into a home birth. That conclusion comes from their own educational and spiritual evaluations.
I can say hospitals are not as safe as people want to believe, and that the maternal infant mortality and morbidity rates are lower at home with a midwife. (See David Stewart, NAPSAC Int., Mehl Study, World Health Organization. I also recommend Henci Goer’s book, Obstetrical Myths vs. Reality.)
The World Health Organization (WHO) publishes yearly a list of western technical nations. In forty seven years the U.S. has continually fallen in the rank. For more than thirty years the U.S. has ranked around 20th in infant mortality. That means that the wealthiest, most highly technological nation/society in the world, where most of the babies are born in the hospital under the management of medical doctors has more babies die per year than in places such as: Singapore , Hong Kong, Spain, Japan, or Germany, among others.
"According to Dr. Marsden Wagner of the World Health Organization, the countries with the lowest infant mortality rates in the world employ midwives as the sole attendants for at least 70% of all births." quoted from Midwife Means "With Woman." publication of the California Association of Midwives.
Q My husband is very nervous. How can I calm him?
A Childbirth classes go a long way in relieving the fears of childbirth. Knowledge is power. When you know how the process works, what to expect, and look objectively at what you can do to help pregnancy, labor and birth, much of the tension is eased.
However, your husband's fear can stem from a lack of faith in the childbearing process, from horror stories he has heard.
Furthermore, a lot has to do with programming and mind set. For, instance, the media has stereotyped men. When it comes to helping women have babies, husbands are shown to be bungling fools. (Recall, " I Love Lucy" - the episode when she went into labor had one of the highest ratings in television history) Fear and incompetence in this arena is ingrained, and images are hard to shake.
Assure your husband that he is capable of giving you what you need emotionally and physically in childbirth. And as some added relief for him, hire a labor companion/doula. She will provide you and him with the support you need, acting as your coach, advocate and on the spot childbirth educator.
Q For a variety of logistical reasons it is important that this baby (my third) be on time. My first was 4 days early, my second was two weeks late. What natural methods do you suggest for getting the little buggers out on time? Castor oil and nipple stimulation did nothing for the last one (nor did seemingly constant sex!) My midwife finally stripped my membranes to get things going last time, but they won't do that until I am late again. So, would it help to try blue and black cohosh starting at 38 weeks? What else? Help! My mom and sister both go back to school on 8/22, so if they are going to be here to bring the older kids to the birth then this one has to be one time.
A Sorry I cannot help you on this one. Babies come when they're ready, not at your convenience. What's on time for you may not be on time for him/her. Furthermore, are you making room for baby or does baby have to make room for you. An will induce you with Pitocin on or before your due date (usually for his convenience). Then if the Pit doesn't work he can perform a c-section. Then if your baby's lungs aren't mature s/he can spend some days or weeks in the NICU. Induction should not be taken lightly.Midwives are her to guard birth, not control it.
Not all baby's come at 40 weeks. About 4% come on their due date. I've seen 43 week babies look like 40 weekers. Most of the time if your body is well-nourished and ripe, babies come on their own. Castor oil, nipple stim, cohash, acupuncture, will give you a jump start if your baby/body is ready. The placenta and the baby and the heavens decide when baby needs to exit.
Q Do you have a birthing center?
A No. I think women labor and birth better in their own nest; feel more comforted in their own homes; and have what is called the home team advantage when birthing on their own turf.
Though free standing birth centers (I am not referring to the re named maternity wards in hospitals which is a misnomer) can be popular and a seemingly good alternative to the hospital experience there are drawbacks.
The difference between delivering at a birth center or at home – at home you don't have to leave and ride in the car when you go into labor, the midwife comes to you. With a birth center - you must travel in labor. Often there is a time limit on labor at a center- 8 hours of labor and you could be transported to the hospital. (See Carl Jones' book, Alternatives in Childbirth for a discussion on the benefits of home birth and the disadvantages of a birth center.) Additionally, the expense of your birth may be more with a birth center birth because of the overhead associated with a birth center.
Be aware that complications at a birth center are handled as well as at home, actually the same. A midwife (at home or in a birth center) is trained in neonatal CPR/resuscitation, uses medications to control hemorrhage, carries oxygen, etc. Many of these protocols are the same - hospital, birth center or at home.
Furthermore, a serious complication at a birth center and one that couldn’t be handled at home would require a transport to the hospital.
Q I am 7 weeks pregnant. What vitamins should I take?
A I highly recommend a multiple vitamin without iron once a day with a meal; 2000 mg. calcium/500 mg. magnesium (taken together in a 2 to 1 ratio) on an empty stomach with vitamin C; and a complete B complex, also taken with vitamin C for absorption and with a meal.
Two B vitamins, B6 and folic acid, are especially beneficial to pregnant women. A deficiency in folic acid has been linked to birth defects, and a low platelet count in the maternal blood. Platelets are an important part of the clotting factor in blood. A low platelet count could result in a hemorrhage at birth. B6 is good for morning sickness.
Many women think that they should take the prescription prenatal vitamin often recommended by their ob. These supplements contain too much iron, and the fillers usually make mothers nauseous. They do not contain enough calcium/magnesium
Q What if complications occur during labor or childbirth?
A Midwives are trained to handle complications, such as hemorrhage and neonatal resuscitation
Q What happens in the event of a breech birth?
A Normally a breech can be ruled out during your prenatals and many times turned to a head down position prior to going into labor. Rarely will a baby turn breech just before labor. At that time, if the mother is a first timer with time to deliver, she is transported to the hospital. If the mother is not having her first baby and birth is imminent, the baby is born breech, a successful outcome usually occurs.
Q How would you handle my pregnancy if my water broke and I did not go into labor?
A Briefly, the treatment for Premature Rupture of Membranes (PROM) depends on many factors. One is: is it a gush or a leak? Leaks can seal over. If you are close to your due date and it is a gush I would tell you to encourage the onset of labor; restrict tub bathing, intercourse, etc.; take your temperature every four hours; and up your fluid intake.
Though most well nourished women do not have this complication, sometimes leaks occur in the amniotic sac prior to 36 weeks gestation and may indicate an infection, and referral to a medical doctor is important. In any case if the fluid is clear or colored or has a foul odor, these factors will have a bearing on the treatment of this condition. Every situation is treated on an individual basis.
Q My British wife says it is common for new mothers to eat the placenta. Can this be true? Please reply, I've got to know if my wife is a cannibal.
A Its common for new animal mothers to eat the high-energy, nutrient rich placenta, but raw. As far as humans - they prefer a pate or freeze dried version. There was once a recipe for the pate delivered to me by a midwife friend of mine. Her client crushed it in a blender and served it to the "birth" day party attendants on crackers. My friend is a vegetarian and declined to sample.
I attended the wife of a Doctor of Chinese Medicine once. They intended to freeze-dry the placenta, serving it to their son in capsules on his possible low energy days later in life - his first day of school, for instance.
If your wife has a good Brit recipe, ask her to send it along
Q I am interested in learning more about a water birth. My biggest concern is how it affects the baby to be born in a water environment. Is there any risk of the baby breathing in water, and how do you prevent that? Although I am looking into an unassisted birth, I don't feel confident enough in doing an unassisted water birth.
A Babies do not breath (which happens when the alveoli fill with air) until they contact the air. The alveoli are filled with fluid prior to breathing. During a water birth a baby will go from one watery environment to another and are quickly brought up to the surface. The biggest risk is if a baby is born in a pool that is contaminated with blood or feces. If those particles were to go into the lungs there could be problems.
Q Water Birth sounds interesting to me, but at the same time it also sounds risky. And from what little I can gather, not many midwives do a water birth.
A I do not know how many midwives do water birth. I never thought it was a big issue.
Q You said to be careful during an OB or midwife interview and ask questions. Are there specific questions that I should definitely remember to ask that I might not think of at the time?
A Write your questions down before you go to the interview with a potential midwife or doctor. I would ask about the midwife's experience, training, what equipment she brings to the birth, does she know neonatal resuscitation, how does she handle complications such as hemorrhage, when does she come out to the birth, does she have time limits on labor, who does she have assist her and will you get to meet this person.
Q What kinds of services are included in a midwife’s prenatal care?
A All the medical ones that you may need or desire. This includes any lab tests or ultrasounds. However, a midwife’s services go beyond that to include nutritional information, remedies for common pregnancy ailments and education. It usually includes home visits, and such things as her taking calls in the middle of the night.
Q In a "hands off" philosophy to midwifery, what is the actual role of the midwife?
A The midwife is your educator and life guard. She is also a member of a team - you, your partner and her have to work together to deliver the baby. She knows what is normal in labor and birth and is ready to step in if complications occur. She monitors the heart rate of the baby, applies perineal support and oil to your perineum, helps you deliver the placenta, watches for abnormal bleeding, helps you to get the baby latched on correctly, monitors and massages your uterus so that you do not bleed, does a newborn exam, among other things.