Super model Gisele Bündchen gave birth to son, Benjamin, at home, in a deep bathtub, attended by two midwives six years ago. Bündchen meditated throughout the birth. “It was the most amazing experience of my life,” she later told Vogue. “Feeling him come through my body. And once he was born, I never felt so empowered, looking at him and thinking, ‘Oh, my God, we did it together!’” While the rest of us aren’t as perfectly endowed as Bündchen, she’s a well-known representative of earth-mom leaning millenials everywhere. The uptick in babywearing (the practice of carrying or “wearing” your baby in a sling or carrier) and cloth diapering (keep those super absorbent polymers — SAPs — away from my baby!) underscores a new-mom passion point: the desire to have less intervention in childbirth and to let nature take its course. That means less non-stop fetal monitoring, fewer inductions, fewer cesareans, less use of forceps and vacuums. The needs for deepening personalized care for mothers before, during and after childbirth has many moms taking a look at doulas and midwives.
Today’s Tennessee cesarean rate is 33.7 percent (according to 2014 data from the Centers for Disease Control), slightly higher than the national average of 32.2 percent and much higher from 20 years ago when the U.S. average rate was 20.7%. The skyhigh rate leaves many women with a question mark in their minds: will I or will I not be able deliver vaginally, and will I have a say in that process? Significant research shows that less intervention in childbirth is associated with healthy low-risk pregnancies. Also, women who are better educated about childbirth better empower themselves for the rigors of labor, and that’s where partnering with a midwife and/or doula can make the difference in the delivery room.
TYPES OF MIDWIVES
Certified Nurse Midwife (CNMs): A midwife trained and licensed in nursing and midwifery. CNMs must have at least a bachelor’s degree from an accredited institution. They are also certified by the American College of Nurse Midwives (ACNM). Because CNMs are nurses, they can attend hospital births.
Certified Midwife (CM): An individual trained and certified in midwifery. Certified midwives must have at least a bachelor’s degree from an accredited institution. They are certified by the ACNM. Certified Professional Midwife (CPM): An individual trained in midwifery and meeting the standards of the North American Registry of Midwives.
Direct-Entry Midwife (DEM): An independent individual trained in midwifery through various sources that may include apprenticeship, self-study, a midwifery school or a college/university program. Lay Midwife: An uncertified individual who has received training through self-study and apprenticeship.
When pregnant, many women simply “fall in” to the routine care offered by their OB/GYN and the hospital they’re associated with, not realizing it doesn’t have to be that way. Vulnerable and exposed in childbirth, they are often powerless to question the course of their delivery. A midwife can speak up for you. “Absolutely,” says Lori Cabbage, MSN, CNM, an instructor in clinical nursing and a certified nurse midwife through Vanderbilt. “CNMs are experts of normal pregnancy and birth. We encourage education and involvement in decision making. By doing this, it empowers women to take responsibility for their own bodies,” she says. Major decisions expectant mothers make can influence the care they receive and the effect of that care on their body and baby; the quality of their relationship with their care provider(s); how much information they get on choices and options during labor and birth; and their involvement in decisions about their care. Sometimes though, no matter what, childbirth doesn’t go as planned. “We value appropriate intervention, meaning, intervening when there is a purpose and sound rationale,” says Cabbage. “But we will not induce a woman’s labor simply because her cervix has started to change,” she adds. Women who want more control over childbirth feel labor should begin on its own and that they should be encouraged and supported to labor as they choose. But it’s not easy for women to remain calm and relaxed in labor — that’s where doulas and midwives come in. “Couples will choose a midwife to obtain nurturing, holistic, personalized care that has a focus on the positive,” says Mary Anne Richardson, CPM, RN, EMT. “Midwifery care incorporates education about diet, exercise and natural birth with clinical skills to reduce complications such as C-sections,” she adds. Doula — not to be confused with midwives — refers to trained and experienced professionals who provide continuous physical, emotional and informational support to mothers before, during and just after birth; or who provides emotional and practical support during the post-partum period. Like nurse-midwives, doulas have significant experience in the delivery room. Depending on your preference and ability to afford it, you can employ both a midwife and a doula for your delivery.
AMERICAN COLLEGE OF NURSE MIDWIVES
Professional association representing CNMs and CMs in the U.S. It sets the standard of excellece in midwifery education and practice.
Baby + Company
3212 West End Ave., Ste. 100, Nashville
This fully licensed birth center is staffed by Vanderbilt nurse midwives to provide low-intervention births. Water birth is available as is nitrous oxide. Labor and birth services, education, wellness and personalized clinical care.
DOULAS of NORTH AMERICA
An international network for doulas seeking training and certification. Locate doulas in your area, also.
The Farm Midwifery Center
198 Second Road, Summertown, TN 38483 931-964-2293 thefarmmidwives.org
Prenatal care, support during labor and delivery and afterward by a group of six CPMs.
Midtown Midwifery & Women’s Health
601 Benton Ave., Nashville
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2637 Murfreesboro Pike, Nashville
Prenatal care and midwifery available for the underinsured or uninsured through University Community Health Services. Midwives deliver at St. Thomas.
Birth or post-partum doula services in addition to lactation support, placenta encapsulation and more.
Birth and post-partum doula services in the Nashville, Brentwood and Franklin areas.
Nashville DOULA DIRECTORY
Database of local doulas in Middle Tennessee.
Nashville Birth & Babies
A network of independent birth professionals including birth doulas, post-partum doulas, hypnobirth instruction, placenta encapsulation and more.
Nashville Birth Network
An alliance of individuals and organizations in Middle Tennessee with concerns for the care and well-being of mothers, babies and families; includes a directory of childbirth support.
St. THOMAS MIDTOWN
2000 Church St., Nashville
Midwives available through Midtown Midwifery & Women’s Health at Vine Hill. Doula services available. Labor tubs and more.
1725 Hill Road, Eagleville
Midwifery practice offering complete prenatal care for a safe homebirth. Water birth, doula and monitrice services.
Tennessee Midwives Association
Supports and promotes the option of birth at home for childbearing families.
Vanderbilt Nurse-Midwives West End Women’s Health
2611 West End Ave., Ste. 380, Nashville
Vanderbilt Nurse- Midwives at Melrose
2410 Franklin Pike, Nashville
Cole Family Practice
226 Jackson Meadow, Hermitage
The Vanderbilt School of Nursing faculty nurse-midwife practice is available at three different centers in Middle Tennessee. Women receive prenatal care at the centers and deliver in the care of a nurse-midwife at Vanderbilt.
Vanderbilt University Medical Center
1211 Medical Center Drive, Nashville
Midwives available. Labor tubs, nitrous oxide for pain relief and more.
What happens to a mom when an emergency situation comes up in childbirth? “Things can change quickly in labor,” Cabbage says. “Sometimes babies get in positions that compromise blood flow through the umbilical cord. Other less-common emergencies might be placental abruption which is presumed when an increased amount of vaginal bleeding is noted, or perhaps a prolapsed umbilical cord (where the cord comes out before the baby). These are true obstetrical emergencies and the unborn baby’s life depends on a swift delivery.” If a medical emergency arises in childbirth at home or in a birthing center, a transfer to a hospital will take place. As today’s child-bearing women look for more personalized care and the “less intervention” philosophy that midwives and doulas subscribe to, the National Center for Health Statistics shows hospitals are listening: Induction rates have declined since 2010. And, after an alarming 13-year increase in the U.S. cesarean rate, that number is finally showing stubborn indications of decline. Meanwhile, more can be done. Just last year, a major study by the National Partnership for Women and Families titled Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies and Maternity Care concluded that the U.S. maternity care system can provide better care and use resources more wisely to stop intervening in labor and delivery and instead promote, support and protect the innate biological processes that result in healthier outcomes for women and newborns. In the meantime, pregnant women must empower themselves with knowledge and do the outreach it takes to “own” their birthing experience when the times comes.