May 2020: Midwives and Mothers!
Best Start Birth Center is celebrating Mothers’ and Midwives all month long! Mothers’ Day (May 10), International Day of the Midwife (May 5/ Cinco De Mayo)
In support of Certified Nurse Midwives in California, Best Start hopes you will reach out to your legislators in support of SB-1237 to remove physician supervision from Certified Nurse Midwife practice. Certified Nurse Midwives are Advance Practice Midwives who specialize in natural childbirth. Best Start Birth Center believes that all women with low risk pregnancies should have access to midwifery care and that midwives are the obvious choice for every newly pregnant, low risk woman seeking natural birth. We need our medical system to operate as a HEALTHCARE system. Not all women want or need unnecessary interventions which have not been shown to be evidenced based. In some cases unnecessary interventions can even be detrimental.
Best Start Birth Center participated in CMS Strong Start Study which showed superb outcomes for Medicaid population utilizing the midwifery model of care. There is no reason we can not replicate these findings for all US women and babies. We simply need to allow midwives to practice to the full scope of their licenses. Midwifery care in freestanding birth centers just makes sense. Less costly to the HEALTHCARE system and women who are low risk simply do better under the Midwifery Model of Care.
The United States has poorer outcomes and more pregnancy-related deaths than most other developed nations.This is not new information. While there is much evidence to show that utilizing midwives increases positive outcomes, there is a lack of support for allowing midwives to practice to the full scope of their abilities.
Under the ACA, Midwifery care in freestanding birth centers is an entitlement of the the Medicaid system if licensure exists in the state. This is true for California under the Medi-Cal system. Women with PPO insurance are also generally able to gain access to midwifery care in freestanding birth centers. However, this is most often prohibited for women with commercial HMO insurance plans, as many HMOs are owned by hospitals that want to keep all care “in house”. Best Start believes all women including those with commercial HMO insurance, should have access to this same high quality care. How do we change this? Consumers need to drive the demand for better care. Women who have commercial HMO insurance meed to request their employers and partners employers, ensure that midwifery care in freestanding birth center, be included as a plan benefit.
Our current maternal care system is not aligned to provide evidenced based care with mothers’ and babies’ best interests in mind. In addition, there is monetary incentive for practices that increase maternal and infant mortality. Women have repeatedly asked for practices that have been proven by evidence to benefit them and their babies and to cease practices that are not evidenced based and can cause harm. Examples where we could do better supporting normal, healthy childbirth by practicing the Midwifery Model of Care include:
- Delayed umbilical cord clamping– a common practice of midwives. Women wanted to slow the transition from fetus to newborn—to enjoy cradling their little one during this time. Now modern evidence is finally catching up. World Health Organization recommends the practice of delayed cord clamping enhances the well being of newborns– most especially the preterm newborn.
- Avoidance of episiotomy– The absence of routine episiotomies enhances safety for women in labor and is practiced by midwives
- Birthing in water– At Best Start Birth Center, we believe that when done safely, water birth is a beneficial mode of birth for mother and baby through relaxation and a reduction in the need for medical intervention.
- Avoidance of cesarean section
- Freedom of mobility and untethered labor.
- Preference of intermittent fetal heart beat monitoring over continuous electronic fetal monitoring, electronic fetal monitoring is not evidenced based.
- Unrestricted presence of partner, family and friends
- Desire for vaginal birth after prior cesarean
Midwives, by listening to women and respecting normal birth physiology, have evolved the best practices for normal childbirth. Based on evidence, women’s wishes are the best childbirth practices and the midwife model of care produces the best outcomes for normal low risk birth. The midwife model needs to be acknowledged alongside medicine and obstetrics.