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April 17, 2012

So I went to see a midwife yesterday for my annual well-woman visit. She was, of course, super cool, because that’s how midwives are. (All of them.) The midwifery model of care views childbirth as a normal life process, and stresses non-intervention wherever possible in supporting it. I’ve researched long and hard for a new care provider for my gynecological needs in town, and considered going with the midwife who was recommended to me by the last OB I saw locally (incidentally, the OB who birthed me nearly 30 years ago – really weird, I know). But since I’m overthinking things I decided I really wanted a midwifery practice, since a single midwife in an office of OBs wouldn’t have another CNM (Certified Nurse Midwife – a master’s level certification here in the U.S.) for backup necessarily. Going with a midwife team would mean that no matter what, an OB would be my backup delivery provider only if a surgical delivery was truly required.

Of course, XY and I aren’t even talking conception yet, but I want to make sure that whatever provider I choose would be someone who would support the kind of birth I’d like: vaginal, natural, focused on me-as-mom as well as protective of the life of my baby. Due to XY’s insecurities (and his mom’s, too) we won’t want a homebirth, although that is something CNMs can provide, as well as CPMs (certified professional midwives, a direct-entry certification. CPMs are usually not allowed to practice in hospitals here in the U.S.). Since XY was a second generation c-section due to failure to progress (probably related to a gigantic head circumference – the same reason his maternal grandmother had to have a section when his mom was delivered), these fears are not unfounded. I don’t mind the idea of home birth for others (my brother and his fiancee are trying to conceive and are very pro-homebirth themselves), but I know I’d feel more comfortable, if surgery were really necessary, knowing it was RIGHT THERE – because for real emergencies (e.g. placental abruption, umbilical cord compression), cesarean sections can be life-saving to both mothers and babies, and every second counts. On the other hand, there is a debate in this country about how many cesareans are “unnessecareans” – meaning they resulted from mismanaged labors that caused a cascade of interventions (the classic example is the Pictocin drip which lead to severe pain which lead to the undesired epidural which lead to the failure to progress diagnosis which lead to the c-section….and the unplanned c-section can have lots of unintended consequences too, like poorer breastfeeding rates and the OWOWOW of recovering from major surgery). Hospitals are NOTORIOUS for having policies that lead to labor mismanagement (and it’s the policies usually more than the individual doctors and nurses that are to blame), mostly because they are so focused on features like no eating or drinking (aside from ice chips) or electronic fetal monitoring, which have not been proven to improve labor outcomes (such as risk of death or cerebral palsy).

So if you’ve decided you want a non/minimal intervention birth but also don’t want a homebirth, what can you do? Well, free-standing birth centers are an option for many people (and they are usually staffed by midwives), but they don’t yet exist in Illinois, although they are legal here. CNMs are common enough here though that many of them even have their own practices, or have strong group associations with existing hospitals. Chicago is a big enough city that it’s worth it if you’re choosing a hospital and midwife group to go with a proximal location, in case of speedy labor, so I focused on the North side (and got to my appointment in 35 minutes on public transit – sweet!). Since hospital policies aren’t exactly featured news on their websites, you have to look instead at the features they do highlight in their “birth centers”: pain management options, features like laboring tubs, and rooming-in postpartum (as opposed to a baby nursery – a nice touch especially for breastfeeding moms). And a group of midwives as possible providers is definitely a must-have. After that? I narrowed my choices down to two hospitals and picked Swedish Covenant based on Yelp! reviews.

(What, you don’t trust Yelp! reviews?)

Anyway, the reviews were right, because my midwife was awesome. She was very reassuring about my concerns like my getting older, pronounced my cervix pink and healthy (and got a mirror at my request so I could see it during the exam), and offered me free samples of a iron plus herb supplement to help with my risk of anemia (since she agreed I should be building up my iron stores pre-conception). When she was feeling my right ovary I noticed it was slightly tender – wondering if that’s the girlball planning on releasing an egg this month? She also told me I’m still young enough and seem plenty healthy so I can lay off XY about all my anxieties relating to possible infertility. When I told XY this later over coffee he of course said, “What’s her name again? She sounds great! Didn’t I always say you should get a midwife?”

Sigh. No ammo in my corner to push The Conception Project yet. Here’s hoping I find that pot of gold soon.

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