In the movies, childbirth always looks the same: medical and frantic. Whether it’s “Knocked Up” or “Nine Months”, the mother-to-be is in a hospital, on her back, hooked up to IVs, and screaming her head off.
What if birth doesn’t have to be the way Hollywood portrays it?
If you knew of other options, would you choose them?
For my Honors project, I did clinical rotations at a county hospital maternity ward and a midwife clinic. My goal was to compare and contrast perinatal care in each setting. Each approaches birth from different perspectives but they have the same goal: healthy mothers and healthy babies.
Both the county hospital and the clinic met the criteria for Level 1 providers per the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. This means they have equal ability to provide newborn resuscitation, evaluate and provide postnatal care to stable newborns, care for stable newborns born at 35-37 weeks’ gestation, stabilize newborns who are ill, and stabilize those born before 35 weeks until transfer to a higher level of care.
Families planning to give birth at the county hospital are frequently given the expectation that medical interventions (which are not always medically necessary) will happen upon arrival: IV fluids, continual fetal heart monitoring, epidurals, and oxytocin or other drugs to induce or speed up labor. While these interventions can make birth less painful, each adds a cumulative 1 in 20 chance that the birth will wind up in an unplanned Cesarean (C-section) birth according to the academic journal Birth: Issues in Perinatal Care. At the county hospital, the rate of Cesarean births was 38.3% in 2014, according to http://CesareanRates.com, which uses data from the Iowa Department of Public Health. The World Health Organization recommends a rate of 10-15% per year.
“Recovery time for a C-section is several days longer with a lot more pain than a vaginal delivery. If you can avoid it, do” said DMACC nursing student Lindsay Jacobs, CNA. She is a mother of 4 who had 2 vaginal births followed by 2 medically necessary Cesareans.
While natural birth is an option at the county hospital, and aids including a jacuzzi, birth ball, nature sounds, and guided imagery are available, staff told me that patients must specifically request them before natural interventions are deployed.
In contrast to the hospital approach stands the midwife clinic in Des Moines. Midwives are registered nurses who obtain a master’s degree for advanced practice and a certificate to attend birth in place of a physician. Midwives’ approach to birth is to work with nature and how the mother’s body works, meaning that the medical interventions listed above are last resorts, and natural methods are first. These methods include massage, food, walking, tub-birth, relaxation, alternate positioning, and letting the labor unfold at its own rate. As a result, the midwife center I visited had a Cesarean rate of 5.6% in 2015.
“Women have been giving birth for millions of years before anyone knew what Oxytocin was,” midwife Rebecca Schleuger-Valadao, ARNP, CNM told me. “Some situations do require medical interventions and that’s fine, but we don’t need to start from the place of assuming that all of those interventions are good and necessary. You can have a joyous, safe, and natural birth.” As back-up for that fraction of patients who did require medical interventions, each of the midwives at that clinic has admitting rights to Broadlawns Hospital in Des Moines.
Ultimately, my project found that a mother’s goals will determine the best match for her. For low-risk mothers who desire a natural childbirth with few or no medical interventions, the midwife clinic would best meet those needs. For mothers who have low to moderately high risk, are tolerant of or desire medical interventions, and feel most comfortable giving birth in the same building as an operating room, the county hospital would be a better fit. In either location, staff are highly motivated to secure the best outcome for their patients.
So if you are planning to have a child and want to look beyond the Hollywood version, it pays to know there are other options.
Liz Rohret lives with 2 housemates and 2 cats in a big yellow house in Boone, where she occasionally sleeps in between working full time and going to nursing school full time. After teaching junior high science in Kansas and then working for the Iowa DNR, she fell in love with healthcare and plans to become a nurse practitioner.