Finding a Midwife
The dual task of finding and choosing a provider may well be one of the most important processes you do for your health care or pregnancy. Finding will be relatively easy since you can search the listings of midwives on this website, or go to the NYS Office of the Professions website and find all the licensed midwives in New York State.
Deciding which provider is best for you will be the more complex process and will require a great deal of thinking and planning in order to choose the best match. Just as you review Consumers' Guide and go to talk with the expert in the field, be it for a home mortgage or insurance, the same process is necessary for choosing a midwife.
Decide on the 'easy' parts, i.e., type of practice, location, birth setting (if birth is the driver for this), then, make an appointment to see the practice space and talk with a midwife. Have all your questions written and in hand so you can clarify any issues, concerns and just get fuller information.
ABOUT MIDWIFERY
Midwifery is a profession that honors women's choices and works to assure access for women to those choices, be it place of birth, primary care, type of birth or life long gynecology care.
The word "midwife" comes from the German words for "with woman." For centuries, midwives have provided holistic, respectful, full-scope reproductive health care to women before, during, and after pregnancy. Today's midwives are committed to continuing that tradition in the context of the modern health care system, and work to assure access to that care for all women.
Types of Midwifery Practices
Today's midwifery practices are of two types: private or hospital-based. In New York City, many midwives work in both private and public hospitals providing care to underserved women through the outpatient clinic system. Midwives in private practice operate in one of two ways: a midwifery-owned practice, in which the midwives themselves own and manage the practice, or as employees of a physician-owned practice. Private practice midwives provide outpatient care in their offices and may attend births in hospitals, birth centers, or at home.
Settings for Birth
The majority of women experience a health pregnancy without problems or complications, and may choose to give birth in any of the three settings: hospital, birth center, or home. Midwives support the right of a woman and her family to choose any of these settings, and can provide families with research and evidence on the advantages and disadvantages of each setting in order to help them make the decision that best fits their needs.
Hospital
Just under 99% of births in the United States occur in the hospital setting. The majority of women who receive midwifery care do give birth in the hospital, and most midwives attend births in hospitals. The hospital is the ideal setting for women who have high-risk or complicated pregnancies, but women who have low-risk pregnancies may find that the environment in the hospital is more medicalized than that in a birth center or at home, often involving interventions such as IVs or continuous electronic fetal monitoring. Midwives can help provide these women with the birth experience that they are seeking by using the midwifery model of care, which is evidence-based, promotes listening to the woman and respecting her desires for her birth experience, and minimizes the use of medical interventions unless necessary or requested by the woman. Low-risk women who give birth with midwives in the hospital may request intermittent monitoring of the baby and the ability to use non-pharmacologic methods of pain relief (ambulation, massage, water therapy). Access to anesthesia and other medical forms of pain relief, however, are also available to midwifery clients if desired. In addition, most hospitals in New York City encourage immediate postpartum bonding, breastfeeding, and rooming-in, all practices supported by midwives.
Out of Hospital Births
Healthy, low risk expectant women are the only candidates for out of hospital birth. The focus is on normal physiology and women are screened carefully. The mother must be free of pre-existing medical conditions and the pregnancy must progress normally. Management of labor is individualized and conducted with a minimum of technology and intervention. The baby will be monitored with a doppler or fetoscope, according to the mother's wishes and evidenced-based protocols. If a complication should arise, a transfer to the hospital will be arranged for further evaluation or treatment, depending on the nature of the complication. If a complication occurs before labor that precludes out of hospital birth, the woman will have her birth in the hospital attended by the midwife and/or the consulting physician.
The mother is encouraged to move or rest in labor, in the tub or shower or just walking, as she chooses. She is encouraged to eat, if hungry. She must drink. The only women who get IVs while in labor are those in need of antibiotic therapy or those who cannot hold down sufficient fluids to remain well hydrated. She may have as many or as few loved ones with her as she wishes. After birth, the baby remains with its parents and breast-feeding is encouraged and assisted.
Homebirth
Homebirth is a unique birthing experience that provides families with a childbirth experience within a context that respects cultural variations, human dignity and self-determination. In the New York Metropolitan area there is a cadre of midwives who provide home birth care that is based on the Home Birth Guidelines of the ACNM which make this a safe and viable option for women who want to deliver in a natural, drug-free environment. Most homebirth midwives have experience with underwater birth and are committed to giving women and families autonomy to birth in their own way.