Fact: Because most births in the US take place in a hospital, it is widely assumed that physicians provide the best care to pregnant women, yet studies show midwives provide equal if not better maternity care. The midwifery model affords significant advantages over the medical model of maternity care. Most midwives offer women personalized prenatal care, respect for birth as a normal process, information enabling them to make informed choices, and encouragement to trust in their bodies innate capacity to carry and birth their child naturally.

While it is true that a doctor's medical education is more extensive in the area of obstetrics, they are not necessarily more experienced than midwives when dealing with a normal labor and birth. While midwives guide a woman through a natural vaginal birth, doctors are trained to intervene.

Midwifery care recognizes the pregnant mother's need for psychological support. The majority of midwives are women. Their first-hand knowledge of giving birth and their sharing of that experience, woman to woman, is invaluable.Pregnant women are less likely to become overly-dependent on a midwife who assists them in becoming educated about the birth process and encourages them to trust their own instincts. In comparison, it is common for pregnant women to see their doctors as authority figures--a role most doctors readily accept or assume.

Even the language most midwives use distinguishes their view of childbirth from that of physicians. Physicians have patients but midwives have clients. A physician "delivers the baby," which implies control, a midwife helps the woman "birth her baby."

�Barbara Harper, RN

This is not to deny the value of medical technology in event of a crisis. Mothers who choose to give birth at home or in a birth center, as well as their midwives and physicians, are thankful when they have a back-up plan and good hospital to go to if the need arises. But all to often birthing women and expectant fathers believe that simply by being in a hospital the mother and baby will have a safer birth and better experience. This is simply not true.

Although only 5% of all births in the US are attended by midwives, midwifery is widely practiced throughout the world. Countries with the highest rate of midwife-attended births (the Netherlands, Scandinavian countries, and Japan) also have the best maternal and perinatal mortality statistics. Maternity care in these countries emphasizes competent prenatal care and education, and empowerment for the birthing woman. All the circumstances--physical, emotional, and spiritual--that may influence the outcome of a pregnancy are assessed, and clients referred to a physician only when there is a medical problem.

Meanwhile in the US, pregnancy is often regarded as a semi-invalid state. Prenatal care is "patient-oriented," focusing on medical examinations and screening for potential problems, rather than on helping women maximize their health and wellbeing so they can "birth" their babies. With the growth of modern technology, women have lost faith in their innate capacity to carry their children safely through pregnancy, opting instead to have their babies "delivered rather than birthing naturally when the time is due. Most women today need reassurance to birth as their body and their baby were designed to do--naturally. However much of what passes for prenatal care today actually increases women's fears by giving them too many names for all the complications that might arise, and too many "just-to-be-sure" tests. Furthermore, many of the tests that are administered routinely during pregnancy have been shown to do more harm than good: despite this fact, these tests continue to be administered routinely in the majority of hospitals throughout the US.

Thankfully, a growing number of women are embracing pregnancy as a time ripe for reclaiming the vitality of their fundamental power as woman, birth giver, and mother, while providing their child with the best possible start in life. Preparing for a natural and normal labor and birth, a woman develops faith in and draws strength from her own instincts and the physiologic wisdom of her body, rather than becoming a passive recipient of "managed care."

Preparing for a Hospital Birth

Since most women today will choose to "deliver" in a hospital, with a doctor, choosing and informing all involved about the kind of birth they want becomes a critical consideration.

It is vitally important that women and their partners know that it is their right and responsibility to be fully informed on the pros and cons of recommended tests and procedures, and their right to refuse any procedure. Many of the interventions that are routinely administered by many doctors during both pregnancy and labor have been shown to cause unnecessary complications.

There is always a price to pay for being submissive. A woman avoids conflict but afterward frequently feels that birth was something done to her, not something she did herself. Women who have suffered a sense of powerlessness in birth may go on to feeling this long after the baby is born. It often leads to their feeling incompetent with the baby too.

--Sheila Kitzinger

Question their cesarean rate, their policy on the use of electronic fetal monitoring and ultrasound, routine enemas or suppositories, intravenous drips, electronic fetal monitoring, induction and augmentation of labor, episiotomy, forceps and Caesarean delivery, drugs for pain relief and epidural. Question whether mothers and infants are kept together round the clock, the support offered for breastfeeding, whether your partner can be with you at all times, how many people you can have in attendance, what percentage of babies she delivers herself (it is not unusual for an unknown doctor to arrive at the height of labor). Birth centers typically have low intervention rates and little interest in separating you from baby, partner, or friends but check on the chance of an unfamiliar midwife or doctor appearing to see you through labor, the number of clients who transfer to the hospital, and the nature of pre- and perinatal education classes offered. A good antenatal class is one where women are encouraged to trust in their body and their ability to give birth, rather than to depend on others to get the baby born for them; and where women can talk freely about their apprehensions as well as their hopes.

Choosing a Birth Attendant and Birth Plan

Whether planning to give birth at home, birth center, or hospital, when choosing a physician--an obstetrician or family practitioner--or midwife--it is important that a woman choose a person who shares, or at least respects her philosophy, and with whom she feels she can build a caring, honest relationship.

Three equally important questions for a woman to ask when choosing a birth attendant are: Is this person experienced in keeping birth normal? Is this person able to handle serious problems if they arise, or get someone who can? Does this person have reverence for the process as well as for me and my baby? Look at the person's hands and ask: Can these hands be gentle yet sure? Look in the person's eyes and ask: Can you care for me, my body, my baby? We need birth attendants and caretakers� who know that they are in service to the birth, not in command of it.

--Suzanne Arms

The Birth Plan

Drawing up a birth plan is one of the most important things that can be done to ensure--to the extent this is possible--a birth is orchestrated as the pregnant couple intended it.

Too often, women leave the design of what may be one of the most precious experiences of their lives--that of giving birth--to strangers. Thankfully, many couples are realizing that they have the right and responsibility to say how they want their babies delivered. If their requests are not clearly known, the doctor, as would anyone, will follow whatever practices she believes to be the most convenient.

A birth plan is a list of the pregnant woman's priorities, needs, and wants, for the birth and the time immediately afterwards. It specifies in writing the general style of birth wanted, e.g., low-tech and epidural- or drug-free and with unrestricted mobility, for example. Ideally, it is something a couple and their doctor or midwife prepare together. It is best it be concise, two pages at most, and note preferred options, should intervention be necessary. Drawing up a birth plan can offer a path to developing dialogue and connection with all those who are to be present at your birth. While even the most well-planned birth may not turn out as intended, a birth plan is a couple's best guarantee of getting what they want.At very least they will know they did their best to ensure an optimal birth.

What Is a Doula?

The best guarantee for having a normal vaginal birth, and of labor and birth following the birth plan, is planning in advance to have a doula--a woman who offers the birthing mother continuous comfort, reassurance, and encouragement during labor, birth, and immediately after birth. She may hold her hand, walk back and forth with her, take pictures, rub her back, affirm that she can and will do this! Of equal importance is her role as buffer and advocate with doctors and nurses for the laboring woman and her partner. Many studies show that the presence of a doula results in a reduction in labor time, risk of cesarean, and use of epidurals. Once in labor, a woman is not likely to argue about birth plan details nor is she in any condition to calmly discuss an unplanned caesarean with her doctor or hospital staff if told that her child is "in danger."

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