When I was pregnant with my first child, my midwife did what any good caregiver would: She kept a watchful eye on my health and my baby's well-being; gave me sound advice for dealing with aches, pains, and anxiety; and helped my husband and me prepare for the birth. And when my due date passed and the doctors she was in practice with recommended inducing labor, Sue gently reminded them (and me) that I wasn't actually "late" until my pregnancy reached 42 weeks. As long as my baby and I were both doing well, she said, there was little reason to give nature a nudge. Sure enough, labor kicked in a day under that 42-week wire, and after the active, natural childbirth I'd hoped for, she placed my squalling son in my arms and cheered, "You did it!"
Only about 7 percent of American babies are born with the help of midwives (by comparison, about 70 percent of European babies are), but these caregivers' down-to-earth, mom-centered approach brings insights, like these, to any expectant woman:
Every mom's unique
There's a wide range of normal in pregnancy, especially when it comes to weight
Most expectant moms worry about the pounds they pack on -- whether they're gaining enough, too much, or at the right pace. But a midwife considers weight in tandem with the overall progress of the pregnancy, especially if the woman started it at a normal weight.
Take-away advice: Relax. A high or low scale reading isn't usually a concern unless it's coupled with other warning signs, such as rising blood pressure (which can indicate preeclampsia) or a small uterine measurement (which can signal poor fetal growth). Just eat a well-balanced diet and alert your provider to any concerns.
What's going on in your head is as important as what's going on in your womb Sure, pregnancy is a physiological process, but it's also an emotional one. (After all, how often are you weepy, delirious, stressed-out, excited, and terrified — all at the same time?) "I ask my patients, 'What's going on in your life? What are you dealing with at home right now? Are you getting the support you need?'" says Janice Sack-Ory, a midwife in Federal Way, Washington.
An expectant woman who's extremely anxious about getting through labor or becoming a mom, for instance, may not be able to focus on caring for herself or preparing for a new baby. A stressful job or an abusive relationship can be even more detrimental -- both have been linked to miscarriage, poor fetal growth, and preterm labor.
Take-away advice: Consider whether your caregiver is someone you can really talk to. Are you comfortable bringing up marital or work issues or your fluctuating pregnancy emotions? If not, is there a member of her staff (a nurse-practitioner, say) who's a good sounding board for these concerns? If the answer is no, you may want to look elsewhere for support, such as a local expectant-mothers' group (offered by many parents' centers) or an online "expecting club."
Education and support are key
Knowledge is power
Education is a midwife's mantra. "The best route to a healthy baby is a mom who has the information she needs," says Nancy Lowe, Ph.D., a mom and a professor of midwifery at the University of Colorado, in Denver.
Take-away advice: Learn as much as you can from books, classes, magazines, and the Internet. "Go to your appointments armed with questions. Remember, there are no stupid ones — if you're thinking about it, it's worth talking about," says California midwife Linda Walsh. Prenatal tests are a good example: Make sure you know all the options, what they can pinpoint, how accurate they are, and whether you really need to have them all.
Draft a birth plan — a written blueprint of your "ideal" labor and delivery — or at least carefully consider beforehand how you feel about pain medication, fetal monitoring, labor positions, and the like, and tell your provider well before your due date what your wishes are. As long as everything goes well, you can and should have a say when it comes to the details of delivery.
Support is essential during labor and delivery To help Amanda Seeff-Charny, a Glen Ridge, New Jersey, mom of two, relax during her first labor, her midwife gave her a massage. When contractions seemed to burn through her back, she showed Seeff-Charny's husband how to apply counterpressure. When it was time to push her baby into the world, the midwife massaged the tissue at the entrance of the birth canal to prevent tearing.
Midwives are by a woman's side from the time she's admitted to the hospital until well after delivery, providing constant moral support and physical comfort and helping the birth along. (A good nurse can provide the same things, though nurses often need to divide their time among several women.)
Take-away advice: Make sure your partner prepares for his role in the delivery room. Take childbirth classes together and practice what you've learned at home. You may also want to recruit an experienced, knowledgeable, and supportive relative or friend to help see you through labor and delivery. Or consider hiring a doula, a professional labor assistant; the cost averages $500 but varies from state to state. (For a referral, go to DONA International at dona.org)
Let nature take its course
Midwives (and many doctors) view childbirth as something that needn't require medical interference, such as fetal monitoring or giving Pitocin, a drug used to speed labor. Research has shown that having fewer interventions results in fewer tears, less bleeding, and a faster recovery.
When Lisa McGuire's contractions stalled, her midwife held off on Pitocin and encouraged the Carbondale, Colorado, mom to try nipple stimulation, a warm shower, and various labor positions first. "Those three simple things did the trick — I went from five centimeters to fully dilated in twenty minutes," says McGuire.
Take-away advice: "Ask how often and under what circumstances your caregiver does continuous monitoring, performs episiotomies, uses forceps or vacuum-extraction, and does c-sections," Walsh advises. If your ob has many high-risk patients, of course, the intervention rate will be higher. You want to get a sense that she uses technology on a case-by-case basis rather than as a matter of routine.
Spend as much time laboring at home as you can. In familiar surroundings you may feel more relaxed, which helps labor progress, and you avoid getting on the high-tech treadmill sooner than you may want to.
Your body knows what to do What expectant mom doesn't worry, at least secretly, that labor will be overwhelming or that something will go wrong during her baby's birth? Rest assured: The female body is designed for labor and childbirth. "It's something you do, not something that happens to you," says Lowe.
Take-away advice: Of course, having an active role in the birth process isn't the same as controlling it. Familiarize yourself with the stages of labor, practice the breathing exercises you learn in childbirth class, and know your pain-relief options. But be realistic: Breathing techniques often fly out the window when contractions are coming fast and furious, and even if you have your heart set on an epidural, you may have to power through part of labor without one.
Midwives know that it often helps to go with the flow. Get into whichever positions feel comfortable; grunt or yell if you want; take a bath or shower if you can; or just try to tune in to your body's cues rather than rely on the monitor or the nurse. For me, that meant switching my brain off, hunkering down on all fours during each contraction, and emitting a groan that seemed to come from my core.
Enjoy the fruits of your labor
Cuddle time following delivery is important for babies and moms
Holding your baby right after birth can help soothe and calm him after the rigors of delivery. And it can help with breastfeeding: "If newborns have skin-to-skin contact with their mother, they're apt to get on the breast and pick up nursing more quickly," says Walsh. Nursing soon after birth helps you, too, by stimulating uterine contractions, which reduce bleeding.
Take-away advice: To make sure you get this special time with your newborn, tell your provider you'd like to hold your baby immediately after she's born. Ask that routine procedures, such as giving antibiotic eye drops, be put off for an hour or so, if possible.
Once you're moved to your room — if you're up to it and your hospital allows it — request that your newborn "room in" with you instead of being bundled off to the nursery to spend most of her time.
With these insights in mind, you'll be set to get the most out of your whole nine months, and beyond.
Leah Hennen is a freelancer writer.