Hospital, Birth Center, or Home?
Although there seem to be no disadvantages to working with a CNM in tandem with a doctor and delivering in a hospital, other types of midwife care have drawbacks that should be considered carefully.
A home birth with a direct-entry midwife, for instance, has potential risks. In an emergency, a woman would need to be transferred to a hospital, meaning crucial time could be lost. Plus, a home birther may find emergency personnel less than sympathetic. "Unfortunately, I've known doctors who think that anyone stupid enough to attempt a home birth deserves whatever happens to them," says Don Creevy, M.D., an obstetrician in Portola Valley, CA.
Birth centers have potential pitfalls as well. While all CNMs have physician backups, the doctors are not usually at the center, so again, a woman would have to make the trip to a hospital if anything serious went wrong. In addition, some women are uncomfortable with the "up-and-out" philosophy of many centers. "I had two separate tears from the birth, so I wanted to rest for a while," says Karen Prince of Silver Spring, MD, "but the nurse-midwife made it very clear that I couldn't crash there. I was home five hours after my baby was born."
Any woman who is considering a birth-center delivery -- especially one who's never experienced labor -- should also think about the no-epidural policy of many centers. Even mothers who were determined to have natural childbirth (like myself) have been known to reconsider in the middle of a particularly long or difficult labor.
Despite the growing consensus that nurse-midwifery is safe and effective, the profession still faces traces of opposition. Some physicians see CNMs as an economic threat, particularly those midwives who go into independent practice; others condescend to what they perceive to be the hippie in Birkenstocks who's not performing genuine medicine.
But with the focus on the bottom line (see "How Much Do Midwives Cost?"), and women continuing to demand the best in pregnancy care, most experts agree that midwifery is the wave of the future. The state of Florida, for instance, which has a shortage of practicing obstetricians due to the extremely high cost of malpractice insurance, recommended not long ago that 50 percent of low-risk births be supervised by CNMs. Deanne Williams, executive director for the American College of Nurse-Midwives, expects the trend to continue: "Our goal is to produce 10,000 CNMs by the year 2001," she says. In order to reach that figure, the number of midwife-attended births should more than double from what it was about three years ago.
The glowing reports from women who have delivered with midwives certainly suggest that pregnancy care is headed in the right direction -- even if the changes are a while in coming. "I still meet people whose eyes widen when I say I had my baby with a midwife," says Peg Conway, a mother of two in Cincinnati. "They say, 'You did what?' as if I had the baby in the backyard or something." But Conway was thoroughly delighted with the whole process. "Not only was my midwife there the entire time, but she came by my hospital room the next day and asked me if there was anything I wanted to talk about," Conway says. "I wouldn't have done it any other way."