There are basically three kinds of training for midwifery; CPMs, CNMs and DEMs. Although there are a few others designated. The midwives training is different as well as their licenses. I thought for clarity sake I would share them with you. Although the restrictions of the type of care they can provide varies from state to state. I have gathered this information from the websites that represent the different types of midwives.
Showing posts with label Careproviders. Show all posts
Showing posts with label Careproviders. Show all posts
Sunday, January 16, 2011
Friday, December 24, 2010
My Compliments to Dr Robbins
I was delighted to work with Dr. Richard Robbins at my last birth. He knew this mom wanted a natural, lesser intervened birth. Her water broke and she waited several hours to go to the hospital. I arrived a few hours after she was there, not yet in labor. The Pitocin was started and I was there to meet her soon after. Dr. Robbins arrived a short while later and entered the room with the greeting of, "Hey Stud!" to the mom. I loved it. He chatted about how his wife had a natural birth with their first two but the third was a much longer labor and after several hours she chose the epidural. He mentioned that this baby was a bigger baby by a pound. This caused my client to ask if a pound made a huge difference. She asked this since the sonographer had said this baby was at least a pound bigger than her first one. Dr. Robbins said, "Nope! Should not be a problem at all!" He stayed a short while and when he left he said as he shook his hands in the air, "Let's keep these out and let you do what you are doing so well!" I wanted to kiss the man! He was so encouraging to my client!
Wednesday, June 30, 2010
Vaccine Friendly Docs in Your Area
Did you know you could go to Dr Sear's website and there is a link to information about vaccines- schedules that may be more baby friendly and also a link to a page of pediatricians who will respect alternative schedules? Click Vaccine_Friendly_Doctors to find a care provider in your area!
Monday, May 4, 2009
Crisis Initiates Growth...Choosing a Care Provider
"Sometimes it takes crisis to initiate growth." Rachel Naomi Remen
I have had several moms lately who had births with care providers that they needed to fight with in the last weeks in order to even get a semblance of the birth they desired. When they sat down at the postpartum they discussed moving to a different care provider in order to be listened to next time. But sadly it took having a birth they did not love in order to be willing to consider a move to that new provider.
I am often saying, "you don't go to Kentucky Fried Chicken and ask for sushi." I explain that if your care provider is not listening to you when you are fully clothed and not in pain, what makes you think they will do so when you are in labor.
This week I had a mom share that when she talked to her care provider about her birth ideals, they said, "I hope you will rely on our medical expertise to make the right decisions when you are in labor." Which she took to imply that she could not make the right decisions- although she wanted to be fully informed. They were letting her know who would be making the decisions for her labor. But you know what? She continues to seek them for her maternity care. It makes me wonder if she will get the birth she desires. She very well may, but she will need to really fight to get it. I don't understand this. Fighting in labor should not be a part of a woman's labor experience.
This week I had a mom ask what would have been different at her birth if she had been with a provider that I encouraged her to consider in her early part of her pregnancy. The fact is, I do not know if the actual outcome would have been different. But I do know she would not have spent the last two weeks of her pregnancy fighting with her care provider, practicing what she would need to say to him to get the birth she desired, and now wondering if things would have been different.
Midwifery care is very different than physician care most of the time. Occasionally you will find a doctor who practices like a midwife. Just as some times you will find a midwife who is powerless and made to jump through hoops that the physicians demand of her. Although I am a strong proponent of the midwifery model of care, the most important things in choosing a care provider is: Do they respect you? Do they involve you in your health care? Do they listen to your concerns? Do they answer your questions clearly and in a way that makes you truly informed? Do they believe you can make good decisions for you? If they are being condescending and flippant to your questions, dismissive in their responses and rushed, I think you know the answer.
If you are having a hard time being heard or listened to- then my advice is change. Women are very concerned about change- but "Sometimes it takes crisis to initiate growth." Don't wait until crisis occurs to initiate the change that helps you grow into the birthing woman you need to become in order to get the birth you desire.
Let's talk about why folks pick a care provider- specifically a maternity care provider. Often times you pick a provider based on a recommendation from a friend. BUT, do you know what kind of birth you want and what kind of birth your friend wanted? Perhaps the thing she loved most was the fact that he induced all of his moms by 40 weeks. And perhaps you were looking for a care provider who based induction on medical need only and did not feel inductions were best for a normal pregnancy. So choosing a care provider based on this recommendation would not be in your best interest.
Maybe you are choosing your care provider based on where they practice- or do their "deliveries." If the care at that facility is the type of care you are looking for, odds are this provider goes along with the protocol at this particular hospital. For instance, if you are looking for a water birth and this facility provides this, chances are the provider does them. BUT don't assume this. Realize that a care provider can determine if he follows the hospital protocol or if he is a bit of a change agent and he is cutting his or her own path at this facility.
Perhaps you are choosing a care provider based on where their office is - especially if you are concerned about where it is in conjunction to where you work. But I often warn folks that this is not a great reason to choose a provider. Just like there may be a favorite restaurant across town that is always worth the drive... so may a care provider be this same way.
Some women feel more comfortable with a care provider of their same gender. I know I steered clear of a male massage therapist most of my life- but found that Harry is the massage therapist for me... and he is a guy! So, be open to possibilities of a person based on more than their sex. Many times we think a woman who has been through childbirth will be the best. But I have to say two of my favorite midwives have never birthed a baby from their body!
I had a client once tell me that the medical school a doctor graduated was very important to them. When I chose to have my breast reconstructed immediately following a bilateral mastectomy, I chose a doctor who did a particular reconstruction technique that was important to me. But for normal births, sometimes the less intervention is the better. Therefore knowing all the fancy technology may not be of grave importance. You have no idea if your doctor graduated in the top of his class or the bottom. You have no idea if he is keeping up with the newest techniques or has been content in not learning anything new. There is one doctor here in Atlanta who is skilled in the old techniques of assisting a mom to birth a breech baby. That skill is one that is dying since few are learning the old ways.
Some will choose their provider based on who is on their health care plan. This is purely money driven as health care costs have escalated. I just would say, sometimes the things we want badly in life are not reimbursable and we have to stretch beyond the limits sometimes. I have clients who choose a home birth or out of network birth in order to get the birth they desire. It costs them but they feel it was worth it.
So, I am going to offer the five reasons why I think you should choose a care provider.
1. Does this provider take time to listen to your desires and then communicates that they will do their best to help you achieve those desires? Do they enter the room knowing your name and welcome a time of discussion regarding your needs and desires? Or do you feel rushed and herded through?
2. Does this provider practice evidence based medicine? Do they read the research and base their protocols on what is best for you or the way things have always been done? For instance a good question to ask may be how many of their first times moms end up "requiring" an episiotomy. It should be a negligible number- that is what evidence shows us. A tear may be harder to sew up but it is better for the mom to sustain a small tear than have healthy tissue cut and then tear into a larger repair.
3. What percentage of patients have a vaginal birth in this practice? Keeping you safe and the baby safe is important- but that does not mean the increase in cesarean births is a price that should be paid for doing so. Cesareans are on the increase in the US and it is definitely due to the litigious medical environment in which we live.
4. Does this provider support the type of birth you desire? I mean it is one thing to say sure you can have a natural birth- if that is what you desire... but if they have most of their patients end up with epidurals, it may be in your best interest to wonder if they do really support natural birth. If they are patronizing regarding your desire for a natural birth they are probably not full of ideas to help you achieve this type of birth. Are they encouraging you to take a class to learn some techniques to help you with your goal? Are they affirming that you can do this?
5. What is their induction rate and when are you considered late? Your due month is between 38 weeks and 42 weeks. You are not officially late until you are 42 weeks. And since so often due dates are subjective, this is just a guess most of the time anyway. If they make comments about nothing good happens after 40 weeks, they may be suspect of a high induction rate.
So, choose your care provider wisely. This is a decision that will effect the outcome of your birth. Your birth outcome can effect the way you feel about yourself for a lifetime. Choose carefully but also realize that if as you "date" your care provider along your journey of pregnancy, you decide that he or she may not be the one you want to be "married" to for the birth... you can change!
I have had several moms lately who had births with care providers that they needed to fight with in the last weeks in order to even get a semblance of the birth they desired. When they sat down at the postpartum they discussed moving to a different care provider in order to be listened to next time. But sadly it took having a birth they did not love in order to be willing to consider a move to that new provider.
I am often saying, "you don't go to Kentucky Fried Chicken and ask for sushi." I explain that if your care provider is not listening to you when you are fully clothed and not in pain, what makes you think they will do so when you are in labor.
This week I had a mom share that when she talked to her care provider about her birth ideals, they said, "I hope you will rely on our medical expertise to make the right decisions when you are in labor." Which she took to imply that she could not make the right decisions- although she wanted to be fully informed. They were letting her know who would be making the decisions for her labor. But you know what? She continues to seek them for her maternity care. It makes me wonder if she will get the birth she desires. She very well may, but she will need to really fight to get it. I don't understand this. Fighting in labor should not be a part of a woman's labor experience.
This week I had a mom ask what would have been different at her birth if she had been with a provider that I encouraged her to consider in her early part of her pregnancy. The fact is, I do not know if the actual outcome would have been different. But I do know she would not have spent the last two weeks of her pregnancy fighting with her care provider, practicing what she would need to say to him to get the birth she desired, and now wondering if things would have been different.
Midwifery care is very different than physician care most of the time. Occasionally you will find a doctor who practices like a midwife. Just as some times you will find a midwife who is powerless and made to jump through hoops that the physicians demand of her. Although I am a strong proponent of the midwifery model of care, the most important things in choosing a care provider is: Do they respect you? Do they involve you in your health care? Do they listen to your concerns? Do they answer your questions clearly and in a way that makes you truly informed? Do they believe you can make good decisions for you? If they are being condescending and flippant to your questions, dismissive in their responses and rushed, I think you know the answer.
If you are having a hard time being heard or listened to- then my advice is change. Women are very concerned about change- but "Sometimes it takes crisis to initiate growth." Don't wait until crisis occurs to initiate the change that helps you grow into the birthing woman you need to become in order to get the birth you desire.
Let's talk about why folks pick a care provider- specifically a maternity care provider. Often times you pick a provider based on a recommendation from a friend. BUT, do you know what kind of birth you want and what kind of birth your friend wanted? Perhaps the thing she loved most was the fact that he induced all of his moms by 40 weeks. And perhaps you were looking for a care provider who based induction on medical need only and did not feel inductions were best for a normal pregnancy. So choosing a care provider based on this recommendation would not be in your best interest.
Maybe you are choosing your care provider based on where they practice- or do their "deliveries." If the care at that facility is the type of care you are looking for, odds are this provider goes along with the protocol at this particular hospital. For instance, if you are looking for a water birth and this facility provides this, chances are the provider does them. BUT don't assume this. Realize that a care provider can determine if he follows the hospital protocol or if he is a bit of a change agent and he is cutting his or her own path at this facility.
Perhaps you are choosing a care provider based on where their office is - especially if you are concerned about where it is in conjunction to where you work. But I often warn folks that this is not a great reason to choose a provider. Just like there may be a favorite restaurant across town that is always worth the drive... so may a care provider be this same way.
Some women feel more comfortable with a care provider of their same gender. I know I steered clear of a male massage therapist most of my life- but found that Harry is the massage therapist for me... and he is a guy! So, be open to possibilities of a person based on more than their sex. Many times we think a woman who has been through childbirth will be the best. But I have to say two of my favorite midwives have never birthed a baby from their body!
I had a client once tell me that the medical school a doctor graduated was very important to them. When I chose to have my breast reconstructed immediately following a bilateral mastectomy, I chose a doctor who did a particular reconstruction technique that was important to me. But for normal births, sometimes the less intervention is the better. Therefore knowing all the fancy technology may not be of grave importance. You have no idea if your doctor graduated in the top of his class or the bottom. You have no idea if he is keeping up with the newest techniques or has been content in not learning anything new. There is one doctor here in Atlanta who is skilled in the old techniques of assisting a mom to birth a breech baby. That skill is one that is dying since few are learning the old ways.
Some will choose their provider based on who is on their health care plan. This is purely money driven as health care costs have escalated. I just would say, sometimes the things we want badly in life are not reimbursable and we have to stretch beyond the limits sometimes. I have clients who choose a home birth or out of network birth in order to get the birth they desire. It costs them but they feel it was worth it.
So, I am going to offer the five reasons why I think you should choose a care provider.
1. Does this provider take time to listen to your desires and then communicates that they will do their best to help you achieve those desires? Do they enter the room knowing your name and welcome a time of discussion regarding your needs and desires? Or do you feel rushed and herded through?
2. Does this provider practice evidence based medicine? Do they read the research and base their protocols on what is best for you or the way things have always been done? For instance a good question to ask may be how many of their first times moms end up "requiring" an episiotomy. It should be a negligible number- that is what evidence shows us. A tear may be harder to sew up but it is better for the mom to sustain a small tear than have healthy tissue cut and then tear into a larger repair.
3. What percentage of patients have a vaginal birth in this practice? Keeping you safe and the baby safe is important- but that does not mean the increase in cesarean births is a price that should be paid for doing so. Cesareans are on the increase in the US and it is definitely due to the litigious medical environment in which we live.
4. Does this provider support the type of birth you desire? I mean it is one thing to say sure you can have a natural birth- if that is what you desire... but if they have most of their patients end up with epidurals, it may be in your best interest to wonder if they do really support natural birth. If they are patronizing regarding your desire for a natural birth they are probably not full of ideas to help you achieve this type of birth. Are they encouraging you to take a class to learn some techniques to help you with your goal? Are they affirming that you can do this?
5. What is their induction rate and when are you considered late? Your due month is between 38 weeks and 42 weeks. You are not officially late until you are 42 weeks. And since so often due dates are subjective, this is just a guess most of the time anyway. If they make comments about nothing good happens after 40 weeks, they may be suspect of a high induction rate.
So, choose your care provider wisely. This is a decision that will effect the outcome of your birth. Your birth outcome can effect the way you feel about yourself for a lifetime. Choose carefully but also realize that if as you "date" your care provider along your journey of pregnancy, you decide that he or she may not be the one you want to be "married" to for the birth... you can change!
Saturday, April 4, 2009
Midwives and Doulas
I received a call yesterday from a first time mom who had hired a midwifery group for her birth. There had been several changes during her pregnancy in the practice and she had begun to question if she needed to stay or find a new practice. I assured her that it is more than just about the midwife- it is about the location for the birth- the mindset of the staff at the hospital and about her preparation and support. But for some reason she had thought that the midwifery approach meant they would "labor sit" with her - being with her the whole labor.
Ronnie Falco discusses the roles of the support people in your labor on her site http://www.gentlebirth.org/archives/doulacar.html and I think it enlightens a person on the differences of each role. Most nurse midwives in a hospital setting will need to be taking care of several women in labor- some may also be seeing patients in the office- and others may be sleeping or eating as they can be on call for entire weekends. For those who select homebirth as an option, most homebirth midwives will come to your home once labor is established or may send an apprentice midwife to you earlier. But they usually believe that the less interference the better. So they will read a book in another room and wait for the mom to truly need her before entering into her space. But the idea of a midwife being able to labor sit with a mom during her entire active labor is a misnomer for the most part.
The midwifery model does lend itself to longer prenatal visits. The average is twice as long as the doctor visit. So she lends herself to a more gentle paced visit where more questions can be asked and answered. She looks at birth as a natural process, not an emergency about to happen. She tends to see things as normal rather than a problem that needs to be fixed.
But the history of midwifery does not show midwives as labor sitters per se. In a village there may have been one midwife. Since birth control was not common in the early villages, often there were many women who were pregnant at the same time. She would be offering prenatal care of sorts to each of those women and would be present at the birth of most of those women. So in the history what we see are five women present during a labor and birth.
These five women include the mom herself, her mother- giving her confidence as the woman who birthed her and offering confidence in her lineage, her maiden- a younger sister or friend who had never seen birth- it is her time to serve and learn by doing so in preparation for her birth, the crone- this was the wise older woman in the village that was there to guide the new mom- this is the modern day doula, and then as birth was more imminent the maiden or the partner retrieved the midwife for the birth. She may have just gotten home from a prenatal or a birth of another mother.
So the question arises all of the time, "If I have a midwife, do I need a doula?" The answer is yes. Many midwives will agree. There are a few who will say you do not need one, that they will be with you. But I have to say in 17 years of doulaing I can count on one hand the times a midwife was with the mom the whole labor. Those situations occurred in either fast labors or where the midwife made a special concession and came in for that mom specifically. So don't count on it.
But if you are looking for a low interventive birth- one where you have the most options and most consideration- see a midwife for your prenatal care and use her for the birth of your baby. On rare occasions you will find a doctor who offers care that is similar in some ways to a midwife... but it is very rare.
If you are looking for continuous physical, emotional and information support during labor then hire a doula. She will meet you at your home if you are laboring there and want her- she will remain with you throughout your labor and stay for an hour or two afterward to help you get settled. She will not do the clinical or medical things that a nurse, midwife or doctor does... but she offers a skill set that is different and provides that emotional support they often would like to give but are unable to do in a hospital setting. At a home birth a doula provides the same services to help you along your journey.
Ronnie Falco discusses the roles of the support people in your labor on her site http://www.gentlebirth.org/archives/doulacar.html and I think it enlightens a person on the differences of each role. Most nurse midwives in a hospital setting will need to be taking care of several women in labor- some may also be seeing patients in the office- and others may be sleeping or eating as they can be on call for entire weekends. For those who select homebirth as an option, most homebirth midwives will come to your home once labor is established or may send an apprentice midwife to you earlier. But they usually believe that the less interference the better. So they will read a book in another room and wait for the mom to truly need her before entering into her space. But the idea of a midwife being able to labor sit with a mom during her entire active labor is a misnomer for the most part.
The midwifery model does lend itself to longer prenatal visits. The average is twice as long as the doctor visit. So she lends herself to a more gentle paced visit where more questions can be asked and answered. She looks at birth as a natural process, not an emergency about to happen. She tends to see things as normal rather than a problem that needs to be fixed.
But the history of midwifery does not show midwives as labor sitters per se. In a village there may have been one midwife. Since birth control was not common in the early villages, often there were many women who were pregnant at the same time. She would be offering prenatal care of sorts to each of those women and would be present at the birth of most of those women. So in the history what we see are five women present during a labor and birth.
These five women include the mom herself, her mother- giving her confidence as the woman who birthed her and offering confidence in her lineage, her maiden- a younger sister or friend who had never seen birth- it is her time to serve and learn by doing so in preparation for her birth, the crone- this was the wise older woman in the village that was there to guide the new mom- this is the modern day doula, and then as birth was more imminent the maiden or the partner retrieved the midwife for the birth. She may have just gotten home from a prenatal or a birth of another mother.
So the question arises all of the time, "If I have a midwife, do I need a doula?" The answer is yes. Many midwives will agree. There are a few who will say you do not need one, that they will be with you. But I have to say in 17 years of doulaing I can count on one hand the times a midwife was with the mom the whole labor. Those situations occurred in either fast labors or where the midwife made a special concession and came in for that mom specifically. So don't count on it.
But if you are looking for a low interventive birth- one where you have the most options and most consideration- see a midwife for your prenatal care and use her for the birth of your baby. On rare occasions you will find a doctor who offers care that is similar in some ways to a midwife... but it is very rare.
If you are looking for continuous physical, emotional and information support during labor then hire a doula. She will meet you at your home if you are laboring there and want her- she will remain with you throughout your labor and stay for an hour or two afterward to help you get settled. She will not do the clinical or medical things that a nurse, midwife or doctor does... but she offers a skill set that is different and provides that emotional support they often would like to give but are unable to do in a hospital setting. At a home birth a doula provides the same services to help you along your journey.
Sunday, November 30, 2008
What Are Some Important Things To Know Before the Birth of Your Baby?
So, you have taken childbirth classes, read a ton of books and now you think you are ready for the birth of your baby. Well, let me share some things you need to know before you give birth. I share these things because recently I have encounted clients who have realized some difficulties that could have been avoided if a few more questions had been asked before the birth of their babies.
Read my article on using your BRAIN. Ask more questions so that you are an informed consumer taking a proactive role now in the outcome of your birth and your bonding experience with your baby.
About your care provider:
Do they understand your birth desires? Sometimes there is no planned time to share what your desires for your birth are with your doctor or midwife. If it is not a scheduled appointment, then ask for a longer appointment time so that you can discuss your desires. Sometimes this is done really late in the pregnancy and it becomes apparent that they may not agree with your desires. But early in pregnancy you may not have formulated your desires yet. So, changing providers, although an option, is not one many people want to do. But don't be afraid to share your desires and your plans expecting them to honor your wishes even if it is not what they would normally do. This is a consumer driven industry and you do have a say in your birth process. The law says they must give you informed consent. Ask questions, you have to live with the repercussions of the decisions.
What is the induction protocol at your provider's office? There are many doctors and midwives that don't even start doing vaginal exams until the 41st week. Then others do them at 36 weeks and arbitrarily do stripping of the membranes each exam thereafter. While others will schedule your induction date after you have gone 40 weeks. You are due between 38 weeks and 42 weeks- that is when you are "late." So, ask ahead of time or before an exam is done what they plan to do. Even better, ask in mid to early pregnancy what their normal protocol is.
What about malpresentations? Does your doctor perform external versions if the baby is breech? Will he let you have a trial of labor for a vaginal breech if you have had a previous baby and have a "proven" pelvis?
If he or she is a solo practioner, who is the back up care provider? Many times you select a solo practitioner and then you find out that he shares weekend call with some other solo practitioner. So much for knowing who will be at your birth. Ask ahead of time about this and set up a time to at least meet the back up, just in case.
About breastfeeding preparation:
What shape are your nipples? If you plan to breastfeed you can overcome problems ahead of time if you make sure you do not have flat or inverted nipples. There are preparation techniques that will help to make it easier to breastfeed. Don't wait until the baby is born to address those issues. Go to La Leche League meetings while you are still pregnant. I can't stress the importance of meeting with other women who are nursing before your baby is born. A pound of prevention is worth a ton of cure!
Do they expect a large or small baby? There are weight limits that cause certain protocols at different hospitals. If so, having a lactaid or SNS system in your labor bag would help to assure if the baby needs supplement due to low blood sugar, you can do so while having the baby at the breast, not a bottle. The best thing to do is not have the baby weighed until you have had a chance to nurse the baby at both breasts. The colostrum goes a long way to raise blood sugars.
What is your pediatrician's stand on breastfeeding? Will he come to the room while you are still hospitalized so that the exams can be done there and your baby can avoid going to the nursery? Did she breastfeed, or did his wife? How long? Even if you do not know how long you plan to do so, it is helpful to find out how positive the environment will be beforehand.
About baby separation:
What is the hospital's protocol regarding baby procedures? Have a baby plan- tell them what you want. Again, they respond to consumer demand. Write a letter to the head of nursery staff and have a copy of it upon arrival. Let them know what you need- a delay in the bath, or eye ointment, or Vitamin K, no circumcision, no immunizations, etc. This is your baby. You decide what you want to have done if the baby is healthy. Routine procedures don't have to be so routine. Room your baby in so that you know what is being done and so you can have bonding time with your baby.
If you want a lactation consultant, ask as soon as the baby is born to have your name on the list. Do they have 24/7 lacatation consulting? Doubt it. Do they have weekend help? Doubtful as well. All the more reason to go beyond the lactation class or books you have read to the attendance of LLL meetings.
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