Call the Midwife!

jeastridge, BSN, RN

October 2-8 is National Certified Nurse Midwife Week.

The story is funnier-much funnier-looking back at it 23 years after the fact: I was in labor. A nurse of many years, mother of two school-age children and getting ready to give birth to a third child, my family doctor husband and I had chosen to go with a nurse midwife in the hospital setting. In my mind, if I could have two children the usual way with some pain medication, then the third time would surely be a piece of cake and that baby would just plop right out. Ok, feel free to laugh at my naÃ¯vetÃ©. At any rate, as I entered transition, my lovely nurse midwife stood by and offered the best comfort she could, a firm massage. But my attention was elsewhere. I glared at my husband, now the one clearly responsible for this predicament I found myself in-I'm going to die, I told him. Gently, oh so gently, he held my sweaty hand and said the most logical thing he could think of-No, honey, you are not going to die. Everything is going fine. Probably not the best choice of comforting words. Long story shorter, the nurse-midwife was able to get me more focused on the job at hand and our healthy son was born a few minutes later, tears of joy filling the room, the anger of a few moments before dissipating with a newborn's squall.

Choosing a midwife over a traditional obstetrician was my choice because I wanted to have a relationship with the person that would be delivering our son. (And of course there was the afore mentioned misguided rationale about easy deliveries the third time...) She was part of a large group of 10 obstetricians and practiced in our local hospital. I also wanted to have as few medical interventions as possible and the opportunity to decrease the chances of having a C-section which at that time had reached all time high numbers.

My CNM arrived at the hospital when I did and she stayed right with us through the process. She attended to my comfort in lots of little ways and yet knew how to be unobtrusive.

So what is a nurse-midwife? They are graduate level trained nurses who offer care to the mother and newborn in hospitals, in birthing centers and in at-home deliveries. Certified Nurse Midwives often practice with obstetrician groups, as mine did, and work closely with them, helping to see patients and providing a different type of care. Additionally, nurse midwives can be the primary maternal care providers in rural areas with a scarcity of obstetrics coverage.

For those who are seeking a home delivery with a CNM it is important to fully vet the practitioner, making sure that her credentials check out. I connected with mine through my obstetrician's recommendation when I realized I would have no choice about who delivered our child since call schedules were unpredictable. All good midwives will help you make a birthing plan outlining possible interventions and complete with contingency plans in case something does not go as planned. We discussed plans carefully and several times during the birth, the obstetrician on call stuck his head in to see how things were going.

In other countries, nurse midwives are much more common than they are in the United States. According to Eugene Declercq, a professor of community health sciences at Boston University who studies American maternity care, in England they have a saying, "Every mother deserves a midwife and some need an obstetrician too." [TheAtlantic.com. Article by Jamie Santa Cruz] As maternal-child nursing has progressed from the highly interventional era of the 70's and 80's, nurse midwifery has a lot to offer families seeking a safe, family-centered delivery.

While world wide standards of training vary, in the United States, CNM are required to have a Registered Nursing license with a BSN, then to take additional course work generally requiring at least three years to complete. After that they sit for national boards and receive certification and licensure. As with all advance practice nursing continued education requirements are stringent and ongoing.

Using a midwife is not the norm, by any measure. In-home deliveries continue to be more of a rarity than a common occurrence. With birthing rooms, infants rooming in and the new emphasis on breast feeding, home delivery may seem an unnecessary geographical choice when the medical center leaves emergency care so close at hand. This can prompt lots of questions from concerned family members. But a good CNM will help the client and family weigh out their choices and make the best decision for everyone. Treating birth as the natural process that it is, CNMs offer a unique perspective in our intervention-minded medical world.

Our CNM stopped by to see us off on the day of discharge. With our precious bundle in our arms, we were full of gratitude for the helpful ministrations of our nurse midwife. We were able to laugh together about some of the details of the delivery. She offered a sweet blessing over our little boy and gave me a hug as she waved us out the door.

Call the Midwife!

About jeastridge, BSN, RN

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