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Midwifery Today
Midwifery in the 21st century?
A decidedly old-fashioned word (the term “midwife” even makes an appearance in the Book of Genesis), midwifery has regained a place of prominence in American society, and in the Chesapeake region.
According to the National Center for Health Statistics, certified nurse midwives and certified midwives attended 312,129 births in 2010 (the most recent year for which there are statistics). The American College of Nurse-Midwives states that the number of CNM/CM births has risen nearly every year since 1989, when the statistics were first made available.
The resurgence of the use of midwives began as a grassroots movement. And, like many such movements, its proponents are strong advocates (some might even say zealots) of the practice. Education and accreditation, however, have helped midwifery become more mainstream in recent years.
Certified Nurse Midwives (CNM) are licensed health care practitioners educated in two disciplines of nursing and midwifery, and are certified by the American Midwifery Certification Board (AMCB). They hold both a bachelor's degree in nursing and a master's degree in nursing, specializing in obstetrics and gynecology.
But what exactly does a midwife do?
Special Beginnings Birth and Women's Center, a freestanding facility in Arnold, explains that in addition to attending births, midwives may provide prenatal and postnatal care, conduct childbirth classes, and provide eastfeeding support.
Gina Owens, practice manager for Baltimore Washington Women's Health Association, points out that “the midwife model of care offers a more holistic approach,” incorporating things like aromatherapy and water births. “A midwife,” she says, “is also there with the mother for the entire labor.” Between January 2012 and Fe uary 2013, there have been more than 100 midwife-supported births at BWMC's Pascal Women's Center.
Shore Health System's Birthing Center also incorporates the latest technology and personnel in their facility. Patty MacDougall, MSN, RNC, Manager of Women's and Children's Services at Shore Health System's Birthing Center, explains, “Our goal is to help laboring patients deliver their babies using either midwives or physicians so that their experience is individualized and patient centered.”
Bay Area Midwifery Center, part of the Anne Arundel Medical Center complex, is a freestanding facility where low-risk deliveries are often made. Women are screened for diabetes, anemia, and preeclampsia during pregnancy, as these are conditions, the Center explains, that may require a hospital birth. A midwife birth shouldn't necessarily be confused with natural childbirth, however. At Bay Area Midwifery Center, “We believe every woman has the right to choose her own method of pain control in labor.”
Mothers-to-be have many more choices these days—not just about who assists them in their delivery, but also where they deliver. After a decline between 1990 and 2004, home births rose significantly (by 29 percent) from 2004 to 2009. This is according to the U.S. Department of Health and Human Services (HHS), which also tells us that home births are more common among women aged 35 and older, and among women with several previous children.
Times certainly do change. In 1900, HHS points out, nearly all U.S. births occurred outside a hospital. By 1940, however, that proportion fell to 44 percent, and to only one percent by 1969. The advent of birthing centers is changing that. The number of birth centers, according to the American Association of Birth Centers, is growing—there are currently 248 birth centers in 37 states and the District of Columbia.
The New Importance of Folic Acid
In 1998, the Food and Drug Administration first required folic acid fortification of enriched grains—in other words, this B vitamin was added to our ead. The government took that step because folic acid had proven an invaluable weapon against neural tube birth defects such as spina bifida. Taking folic acid supplements, starting at least a month before you become pregnant and through the first trimester, has been strongly advocated since. Now the folic acid drum is going to be beaten even louder.
A study just published in the Journal of the American Medical Association showed mothers who took folic acid supplements prior to and early on during pregnancy had up to a 40 percent lower risk of having a child who developed autism. The Norwegian study looked at more than 85,000 children who were born between 2002 and 2008. Foods containing folic acid include those always-important leafy green vegetables, asparagus, dried beans, fruits, peas, and nuts.
Neonatal Heart Disease
We are not talking about heart defects here, but heart disease in newborns. At least that's what a chilling study just published purports. The walls of the body's major artery—the aorta—are already thickening in babies born to mothers who are overweight or obese, according to a small study published online in the Fetal and Neonatal Edition of Archives of Disease of Childhood. Importantly, according to a press release from the British Medical Journal, “the arterial thickening, which is a sign of heart disease, is independent of the child’s weight at birth—a known risk factor for later heart disease and stroke.” Since the sampling for this study (only 23 women) was so small, further study is obviously needed.
Mothers in the Fetal Position
Sleep can be an elusive thing for a pregnant lady, just when she needs it most. Worrying about what position she chooses doesn't help. Linda Burke-Galloway, M.D., a board-certified ob-gyn, and author of The Smart Mother's Guide to a Better Pregnancy, explains why sleeping on your back should be avoided.
When a pregnant woman in her early or late third trimester feels faint after lying fl at on her back, it's called Supine Hypotensive Disorder. Her blood pressure has dropped because her cardiac output has dropped. “The heart can only pump out what comes into it,” Dr. Burke-Galloway says, “so less blood into the heart means less blood going out of the heart and the patient feels faint. How is this avoided? By encouraging pregnant women in their third trimester to sleep on their left side.”
In that position the uterus is no longer compressing the thin-walled Inferior Vena Cava (IVC), a large blood vessel near the spine, but lies against the thick-walled aorta instead. “The aorta ings oxygenated blood away from the heart and to essential organs and tissues,” she says. “Because of the thickness, it's not affected by the weight of the pregnant uterus.”
