Birth Choices – what is right for you?

19 08 2009

Today we have more choices than ever about how we birth. We have the choice of using a doctor or midwife for our practitioner. We have the choice of birthing in the hospital or at home. We can choose who is present at the birth. We can choose to hire a doula. We can choose between a multitude of prenatal classes ranging from hospital-run classes to private classes in Lamaze, the Bradley method or Birthing From Within. We can enroll our older children in Sibling Preparation classes, we can take prenatal yoga or prenatal pilates, we can bring music, pillows and massage oil to the hospital. We can choose to labour in the tub or the shower or on a birth ball. We can play cards or go for a walk. We can birth squatting or standing or via elective cesarean. We can even write up elaborate detailed lists of all of our preferences and give this Birth Plan to our practitioners.

Faced with all of these choices, how do you know what is right for you? How do you know that the choices you made before the big day will still be right when labour starts – especially if you are a first time mom?

Choice, in general, can be a double-edged sword. On the one hand, it is empowering and enriching to be given the opportunity to have a say in what happens to us. On the other, given too many choices or inadequate information to help in our decisions, the process of choosing can cause stress, anxiety and even guilt and depression. And when it comes to birth, it can give the misguided impression of control.

Relinquish Control (even those subconscious thoughts…)

The first thing you can do on your journey towards the right birth for you is to forget about those fantasies of your ideal birth. We all do it: we all have a vision in our heads of the way we hope our birth will proceed. These visions are rarely realistic (unless you imagined in your ideal birth that you would be half-naked on your hands and knees in a roomful of strangers). Birth is a dynamic process and we cannot control what happens. The woman who is determined to get her epidural before she’s finished with the hospital admitting desk may deliver baby at home in the bathroom attended by her partner. The woman who preaches natural birth from before conception may end up with a complication, or labour induction and a cesarean delivery. We’ve all read these stories and hoped it wouldn’t be us. But it could be. So the first step is to let go.

Read everything you can get your hands on
Knowledge is power. If you aren’t a reader, ask questions. Ask all the mothers you know what their experience was like. Ask your practioner all those nagging questions you’re afraid to speak out loud. Explore all the birth possibilities there are. Don’t shy away from those topics that you hope you won’t have to face (like having a long, drawn out back-labour or requiring a cesarean). Don’t write off ideas that are new to you (like homebirth, or hiring a doula). The more you can understand about the way labour progresses (or sometimes doesn’t) and the way labour is managed (or sometimes mis-managed), the better the chance that you will be able to play an active part in the process.

Be Flexible (but know your limits)
That is, be prepared to change your mind. Something that seemed right before birth may no longer be fitting during birth. Hell, something you asked for during one contraction, may not be what you want during the next. Accept the fact that you may need to revise your thinking in the face of new information. However, if at any time, you are uncomfortable with the care you are receiving, be confident that it is okay to assert yourself or have some intervene on your behalf. By trusting your instincts and your birth team, you’ll know when to stand your ground and when to adapt.

Gather good people around you

The people who support you and care for you during labour can make a huge difference. Consider carefully whether you want a doctor or a midwife, whether you will hire a doula and which friends and family members you would like present. Ask your care-givers questions and reserve the right to change your mind if you don’t feel comfortable. The time it takes at first to find good people could make the difference in how your birth unfolds or at least in how you feel (even when things don’t go as planned). Good people will give you information and not rush your decisions, will help keep you focused, will make you feel supported and empowered, will be positive and encouraging and will inspire trust.

Face your Fears
We all go into labour with a mixture of elation and apprehension but it’s good to ask yourself what it is you are afraid of before your water breaks. Hopefully a few weeks before. It’s hard to know how to manage a nebulous, nameless fear. But if you can seriously explore what scares you about birth (and motherhood) before the throes of labour send you into panic mode, the odds are you’ll be better equipped to deal with whatever comes your way. Try, if you can, to go a little deeper into your fears than the obvious like fear of pain or fear of a long labour. What about the pain scares you? Fear of not being strong enough? Fear of losing control? What about a long labour scares you? Facing your fears is emotionally exhausting but it would be a shame to let fear hold you back from the possibility of a truly rewarding experience.

Know yourself, know your situation
This is the easiest part because it might be decided for you. Are you a home-body who feels most comfortable with a few close friends rather than in the middle of a party? Maybe homebirth is an option for you. Are you an analytical person who is comforted by procedures and technology? Are you someone who always wants to be prepared for the worst case scenario? You might feel strongest birthing at a hospital or birth center. Are you totally against medicated birth? Perhaps a water birth is right for you. Is your baby breech? The safest bet for you and your baby could be a cesarean. Was your pregnancy a textbook case or did you suffer from multiple complications? Your health practitioner will be able to explain what your options are based on your personal situation and with a bit of self-analysis and thought, you’ll find the answers you’re looking for.

Often as labour day unfolds, it doesn’t come down to choice at all. We don’t choose when our babies will come or how they will make their entrance. Sometimes, circumstances arise that take the power from the mama and she needs to stretch and bend around the situation she is given. And sometimes, with trust, in our instincts, in ourselves, in our babies, in birth itself, our babies come just the way we knew they would. We do what we need to do and the most right thing of all is that they are safe.





What can I expect from my appointment with a midwife?

15 08 2009

In most cases your appointments with your midwife will run about 50 minutes as opposed to the standard 10 minutes with a doctor. This means that your midwife has more time to explain procedures and tests to you so that you can truly give informed consent (if you choose to). It also means that you get to know your birth team a little better and therefore, may feel more comfortable voicing any concerns you may have.

In the first two trimesters, appointments are once a month and increase to about once a week near the end of the third trimester. Many midwives also offer a few home visits during the first two to three weeks postpartum where they monitor the baby’s health, your recovery and the initiation of breastfeeding.

A typical appointment will include explanation of upcoming procedures and tests and your right to waive any of these that you are not comfortable with or that you deem unnecessary, opportunity for you to ask questions and voice concerns, a routine physical exam that includes measurement of your belly from top of the uterus (fundus), testing your urine, listening to the baby’s heartbeat, taking your blood pressure and occasionally checking your weight. Your first appointment will also include a full medical history.

Midiwves often work in teams of two or three. This means that you will alternate clinic visits between your midwife team so that you have ample opportunities to get to know them. One of them will be on call at all times so that you can access care whenever you need it. As well, they alternate call and you can expect that one of them will be at your birth. Two midwives attend a home birth (one for mom and one for baby) but typically one will attend a hospital birth and be assisted by the hospital nurse.





What is Midwifery?

15 08 2009

Midwives are healthcare practitioners who specialize in normal pregnancy, childbirth and post-partum. Midwifery is now regulated in many Canadian provinces (including British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Nova Scotia, Northwest Territories and Nunavut, with legislation pending in some of the Atlantic Provinces).

In Canada, though all are known as midwives, we have nurse-midwives, direct-entry midwives and lay midwives. Nurse-midwives are former nurses who took additional training to become midwives. Direct-entry midwives have trained in a clinical setting (midwifery school or university) specifically to become midwives without first training to be a nurse. Lay-midwives trained as apprentices or through self-study, do not have formal clinical training and are un-licensed or un-certified.

Midwives treat birth as a normal physiological event which does not require managing and which proceeds best when intervened with as little as possible. Midwives are trained to spot and mitigate problems and complications in the pregnancy and birth. They may work in conjunction with other practitioners including physicians and obstetricians should the need arise and in some cases may need to transfer care if serious complications develop.

Midwives believe that the mother should be an active participant and decision-maker in her care. Midwives are entitled to hospital privileges, can prescribe medications and standard tests and offer choice of birth place (home, hospital or birth center depending on the province).





International Day of the Midwife

15 08 2009

May 5th was International Day of the Midwife. This special occasion is near and dear to my heart. Both of my children were born with the help of midwives and I have spent the last 3 years spreading the word about how wonderful they are.

I exhibited at the 2007 Canadian Association of Midwifery conference in Vancouver. The conference was held in Vancouver that year to also celebrate the 10th anniversary of the legalisation of midwifery in BC. At the conference, I bought a t-shirt that quickly became my favourite (coincidentally, I was even wearing it when I went into labour with my daughter last year) because of the colour, the fabric (organic cotton) and the message – 10 years of Registered Midwives. When I wear this t-shirt I often get asked if I am a midwife (sadly, the answer is no) and I always reply, “No. I just really like midwives!”

Most of my friends have also had the opportunity to experience midwifery care so I occasionally get the mistaken impression that it’s more widespread than it is. Ann Douglas recently shared some of the results of the Canadian Maternity Experiences Survey and I was shocked to discover that only 6.1% of births are attended by midwives.

I was well aware that though Vancouver struggles with a shortage of midwives I was lucky to live there because other communities have no midwives at all. I fervently believe that we need more midwives. Even so, I didn’t realise the numbers were as low as they are.

The theme for this year’s International Day of the Midwife is The World Needs Midwives Now More Than Ever and you can read some info about this from a global perspective at the International Confederation of Midwives website.

What does the picture look like in Canada?

Midwifery is legal and government funded in the Western provinces and Ontario and Quebec. However, the territories and Maritime provinces are still struggling to have midwifery recognized and paid for through the healthcare system.

Province
Regulated
Provincially funded
Practising midwives
Link
British Columbia
yes
yes
120
bcmidwives.com
Alberta
yes
in process*
30
albertamidwives.com
Saskatchewan
yes
yes
5
saskatchewanmidwives.com
Manitoba
yes
yes
40
midwives.mb.ca
Quebec
yes
yes
100
canadianmidwives.org
Ontario
yes
yes
450
aom.on.ca
New Brunswick
in process
no
1
canadianmidwives.org
Nova Scotia
in process*
no
7
canadianmidwives.org
PEI
no
no
1
canadianmidwives.org
Newfoundland and Labrador
no
no
n/a
canadianmidwives.org
Yukon
no
no
1
canadianmidwives.org
Northwest Territories
yes
yes
3
canadianmidwives.org
Nunavut
in process
partial funding
3
canadianmidwives.org

Source: Today’s Parent, March 2009

Some good news:
Despite government regulation since 1998, Alberta just agreed to publicly fund midwifery. The deal was finalized in early April of this year.

Nova Scotia has also proclaimed the Act Respecting Midwifery but have limited coverage to only a few districts within the province.

Some bad news:
The shortage of midwives is quite real and according to this recent Maclean’s article on the Midwife Crisis, it is just a part of a larger crisis within maternity care in Canada. The article’s byline goes so far as to say that “it’s a bad time to have a baby in Canada.”

And in Ottawa, despite the fact that Ontario is one of the provinces that recognizes and funds midwifery care, there’s been a major step backward – the Ottawa Hospital has closed its doors to midwives.

What Can You Do To Support Midwifery in Canada?





Find a Midwife

15 08 2009

Please visit the site for your province to find a midwife near you:

Alberta Association of Midwives (AAM)
www.albertamidwives.com

Midwives Association of British Colombia (MABC)
www.bcmidwives.com

College of Midwives of Manitoba
www.midwives.mb.ca

Midwives Association of New Brunswick
www.birthmatters.org

Association of Midwives of Newfoundland and Labrador Midwives
www.ucs.mun.ca/~pherbert

Association of Ontario Midwives (AOM)
www.aom.on.ca

Regroupement des sages-femmes du Quebec (RSFQ)
www.rsfq.org








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