Tapping into maternal instincts: Empowering women through midwifery
As a pregnant woman, you have options. You can see an obstetrician, a family medicine doctor or a midwife for pregnancy care. Sometimes, you may see a combination. So, how do you decide which choice is right for you?
Lisa Chickadonz, a nurse-midwife with Providence Women's Clinic, East Portland
, is a great source of perspective on the midwife experience
. She sees midwifery as a way to empower women during pregnancy, and as a means to help them experience birth as a normal, physiological process. “Many things in pregnancy and labor cannot be predicted or controlled, but a birth in which a woman’s wishes are respected, and in which she can avoid interventions she doesn’t want, is always a goal worth working toward,” says Chickadonz.
Over the past 25 years, Chickadonz has attended at almost 2,000 births. With each woman, she says, her focus is on the health of the mother and baby, and on the quality of the family’s experience from the first trimester through delivery – and sometimes, beyond (midwives see women for annual exams and other women’s health concerns, as well).
What women seek from a midwife during pregnancy
Women typically choose midwifery
because they seek greater education and support during pregnancy, as well as greater involvement in decision-making. The midwives at the clinic try to give each expectant mom more time during visits than she might get with an OB/GYN, and they put greater emphasis on answering questions and providing information. They offer advice on nutrition and exercise, and they help women cope with symptoms common in pregnancy, such as back pain and heartburn. Just like a physician, a midwife screens for complications, checks the fetal heartbeat, and also makes sure the fetus is growing and developing as it should be. The midwife’s job, says Chickadonz, is to help a woman understand the changes that come with pregnancy, and to offer reassurance throughout.
“I’m very interested in women’s health, and believe that if we give women tools, education and support, we can improve health and reduce the need for medical interventions that women may prefer not to have,” Chickadonz says. “For women who come to our clinic, there’s a mutual understanding that they’re not going to get things that they don’t want and that aren’t necessary.”
Don’t mistake Chickadonz, however, for someone who’s down on the medical establishment. To the contrary, Chickadonz and the other midwives in her clinic are part of an integrated system that allows women to move smoothly to a higher level of care if complications develop. “We have a team model of care that includes several OB/GYNs, but the practice itself is run by nurse-midwives,” says Chickadonz. The midwives do all of the prenatal care and all of the deliveries for healthy women who aren’t in need of interventions. For pregnant women who have moderate risk factors, the midwives and physicians work closely together. And for those who may have greater medical needs due to complications, the OB/GYN will monitor and treat those complications while the midwife continues to be an integral part of the care team. “The training and practice of OB/GYNs focuses more on high-risk pregnancies and surgical deliveries,” she says. “In our practice, we believe in collaboration that makes the best use of each team member’s skills to give the best care for each individual woman.”
at women seek from a midwife in the birthing process
Women also come to midwives for the promise of having a midwife present during labor. For midwives from Providence Women's Clinic, East Portland, being present during a woman’s labor is a commitment they make to each family in their care. And that, says Chickadonz, makes a huge difference in their experience. “I’m there, watching over their safety, and the safety of their baby,” she says. “If a woman or her partner has questions or concerns, they can ask me directly. It’s not a difference in the quality of care – it’s a difference in the experience of care.”
At the clinic, the mom-to-be is encouraged to meet all of the midwives during her pregnancy, so when she goes into labor, she’ll feel comfortable with whichever midwife is on call that day. The midwives at the clinic work 24-hour shifts, meaning they typically are able to be with a woman from the start of labor through delivery, and are even able, in some cases, to participate in the postpartum care of both mom and baby.
Midwives believe that, as a healthy pregnant woman, you don’t need to be hooked to a machine to safely monitor your baby in childbirth, as this can be done while you are mobile; you don’t have to be connected to an IV; you don’t necessarily need anesthesia (an epidural); and you don’t need to be in a bed, lying down. But if a healthy pregnant woman wants or needs any of those things, Chickadonz says, her nurse-midwife will help her get them.
“Our general orientation is to use less medication in pregnancy and labor, because whatever you give the mom also goes to the baby,” says Chickadonz. She notes that instead of narcotics, an expectant mother may be offered alternatives such as massage and acupressure. If a woman reaches her pain threshold, however, Chickadonz makes no judgments about a woman getting an epidural. “All tools are available to us, and all have appropriate uses,” she says. “We want women to be aware of their options and to let us know what their preferences are so that we can provide care that is tailored to who they are as individuals.”
What happens when things get complicated
The ideal outcome is one in which the mom is able to have the birth experience she wants, and most importantly, one in which both mom and baby are healthy. But it’s not always perfect or predictable – facilitating and giving birth – and sometimes, interventions are necessary.
“Just because you come to a midwife, that doesn’t mean you won’t need a C-section,” says Chickadonz. If a woman does need a C-section, the nurse-midwife stays with her and serves as the first assistant during the surgery; the woman never leaves the care of the midwife. “It’s important – especially in the case of an unexpected C-section – that the woman not feel like she’s being abandoned to an unfamiliar provider.”
Safety, she adds, is the No. 1 priority. “That’s why people come to a professional – they want to emerge from the experience with the mom and baby in the best possible shape. There are a lot of variations on how that can happen. We are very strong advocates of evidence-based practice, so there’s both an art and a science to what we do.”
The midwives at Providence Women's Clinic, East Portland have delivered more than 6,000 children in the past 20 years. All of the clinic’s midwives are committed to the health of the mom and the baby, and to delivering a memorable, safe and respectful birthing experience for the parents. For more information or to schedule an appointment, call Providence Women's Clinic, East Portland at 503-215-6262