Why we chose a midwife

When Vance and I opened our minds to the possibility of having a little one of our own, a lot of things were unclear: when would she or he arrive? What would childcare look like when I went back to work? Would we dare to use cloth diapers? One thing was always clear, though: as long as the pregnancy remained low-risk, I'd see a midwife for both prenatal care and the delivery.

A few years ago, I might not have seriously considered a midwife. I didn't know much about midwifery at all, other than that the practice was as old as the Exodus. If you'd asked me back then if midwives were still practicing today, I probably would have guessed that they were rare in the US, sought out only by the crunchiest of moms-to-be. Then I formed a friendship with a woman who was studying to become a Certified Professional Midwife in Florida, and she opened my eyes to the normalcy of birth, and the idea that pregnancy is not an illness to be treated, but something incredible the female body is quite capable of on its own in nearly every case.

While she normalized pregnancy and birth in my eyes, she also normalized midwifery itself. I could write at length about what I mean, and why we ultimately sought out a midwife instead of a traditional obstetrician when the time came, but Ina May's Guide to Childbirth says it best:

The midwifery model of care conceives of pregnancy and birth as inherently healthy processes and of each mother and baby as an inseparable unit. [...] Prenatal visits within the midwifery model tend to be much longer, allowing for more questions to be answered than in prenatal visits in the medical model. The midwifery model of care recognizes the importance of good nutrition as the best way to prevent the most common complications of pregnancy. It emphasizes the importance of companionship and encouragement during labor as a way to minimize technological intervention in the birth process. It does not impose arbitrary time limits in physiological processes.

Good research shows that when the midwifery model of care is applied, between eighty-five and ninety-five percent of healthy women will safely give birth without surgery or instruments such as forceps and vacuum extractors. Within the midwifery model, medical intervention is inappropriate unless it is truly necessary. Labor has its own rhythms, so it is not expected to conclude within any rigid time limit. It can start and then stop, speed up or slow down and still be normal. A laboring woman may move around freely, drink, eat [...] All of these activities help labor to progress. The midwifery model of maternity care, of course, recognizes that medical intervention is sometimes necessary and that it should be applied in these particular cases. At the same time, it maintains that medical intervention may be harmful when it is used purely for convenience or for profit.

Up until the last few hours of the pregnancy, it was a normal, healthy one. And while medical intervention (gasp! surgery even!) was ultimately required for the safe birth of our son, I would change nothing about the care I received through the midwifery model up to and including his birth.

Durham has few options when it comes to midwifery care. North Carolina remains one of the most restrictive states for midwifery practice, one of 12 states in which it is still illegal to practice as a direct-entry midwife (meaning a specialist whose education is through midwifery school and apprenticeship, rather than a doctor or nurse).

But we didn't want a home birth, and I was immediately comforted when the OB who first met with me a year ago spent at least 20 minutes answering my questions one-on-one and gently nudging me toward the midwives at his practice, unprompted. As far as he was concerned, he wasn't needed unless there was something to indicate a complication or extraordinary risk. There wasn't.

My monthly (and later bi-weekly) prenatal visits with the midwives at the Women's Health Alliance lasted an hour each, and through Centering Pregnancy group care we covered topics ranging from breastfeeding to pain management to good nutrition and possible interventions. I spoke freely, listened intently, and ultimately felt better prepared for labor and birth, whatever direction it took. Looking back, one of the most empowering parts of the experience was that I participated in my prenatal care in a meaningful way. Rather than nurses ushering me through the usual stations (weight, blood pressure, protein) at each visit, I measured and documented these data points myself, with their support only when needed.

Image credit: Rebecca Ames Photography

During my marathon labor, most of which was spent at home, I ate, drank, went for walks through Trinity Park (and countless loops inside our house), and visited the midwives for periodic monitoring to make sure the baby and I were safe. I demonstrated a strength I never knew I had, for a stretch of time I never considered a possibility. And with the expert hands of an amazing midwife, we did everything possible to deliver Misha safely without the intervention of instruments or pharmaceuticals.

Ultimately, when circumstances determined that surgical intervention would be necessary, it was that same midwife who pushed my baby into the world like toothpaste from a tube. And that same OB who had encouraged me toward the midwives and answered all of my first-time-mom questions over a year earlier was the attending surgeon. A fortunate stroke of serendipity in the landscape of an endless labor with many hard choices.

Misha is sitting quietly in his vibrating Coco Go Lounger, eyes wide and staring at Vance, transfixed.