Ask An Expert:: Midwifery & Low Intervention Births

We are so thankful that our partner, UCHealth midwife Molly Yeoman, took the time to answer these questions submitted by our community of moms regarding midwifery and low intervention births.

What exactly is a midwife? 

Generally, a midwife does prenatal care, cares for a woman in labor, and sees her after she has her baby for follow up. Most midwives also provide gynecologic care, annual exams, pap smears, and contraception. 

If I have a midwife, do I need an OBGYN too? 

Great question. The short answer is no, you do not need an OB/Gyn too. Your midwife should have a plan for consultation or referral to an OB/Gyn if your care becomes complicated beyond the midwife’s practice. When you have a midwife, you also have an OB/Gyn waiting in the wings should you need one.

What is the role of the midwife during pregnancy, during birth, and after birth?

The midwife provides routine check ups during pregnancy, orders necessary laboratory tests and ultrasounds, and provides counseling and teaching throughout pregnancy.  During labor the midwife closely monitors the health of both mother and baby through the birth process, supports the mother, and of course “catches” the baby.  Midwives like to point out that it is the mother who delivers the baby into the world.  We just catch it.  The midwife continues to closely monitor the health of the mother, and in some practices also the baby, until all are stable.  The mother will then be seen during the six week period after the baby is born to assure continued well-being.

If I want to use a midwife, are doctors okay with that, or do you have a recommendation on an OB who supports using a midwife?

That is such a great question. Usually you see a midwife OR an obstetrician unless they are working together in the same office. You have your baby with whomever you have been seeing for prenatal care.

Ask An Expert Midwife Low Intervention Births | DMMBWhat medical training does a midwife have to deal with complications? 

There are different types of midwives with different levels of training.  Some are called direct entry midwives, and their preparation varies from an apprenticeship with an experienced midwife to a formalized program of education or some combination. Certified Nurse Midwives start with a bachelor’s degree in nursing and then earn a Masters degree in midwifery that includes academic and clinic experience.  This qualifies them to sit for a national licensure exam.  Their training is not only to care or normal healthy women, but also to manage common problems that can occur prenatally, during labor and birth, and after the baby is born.

Who qualifies for low intervention birth?

Most women are candidates for low intervention birth. Healthy women with one healthy baby in a head down position are the best candidates for low intervention birth.  But often women with problems that are well controlled can also experience a low intervention birth. 

What options are there for pain management for low intervention births?

There are many ways to help with relaxation and comfort in a low intervention birth.  Simply the presence of another human being can be extremely comforting in labor.  Massage, warm compresses, position changes, reassuring words, showers, baths, birthing tubs, dimmed lighting, visualization, music, chanting, and prayer can all be effective. The list could go on and on. Many locations also offer nitrous oxide which is a colorless odorless gas often referred to as laughing gas. This gas is very safe in labor and the mother completely controls how much she gets.

What pain management training do midwives have? I’d like to do a natural birth, but know I’ll need support during labor from someone calm who can help me get through it. 

Midwives are well educated in helping you through a natural birth. We come with a very deep bag of tricks that can help you through labor. I will also say that it is not the magic of the midwife that gets you through labor and birth. Women are stronger than they know, and have been giving birth since the beginning of time. You are made to give birth, and are fully capable of doing it. Awakening this confidence and strength comes through excellent childbirth education. Developing the confidence and skills for childbirth sometimes requires time and commitment, but is well worth the investment.

What if you had preeclampsia or hypertension with a previous birth? Do you still qualify for a low intervention birth? 

Pre-eclampsia and hypertension can both come back with a subsequent pregnancy, but not necessarily. What really matters is your health during the current pregnancy. Focus on finding a provider who understands what you are looking for. You want someone who can give you excellent low intervention birth if you are having a normal pregnancy  and can also help you achieve some of your goals even if you develop problems.

Ask An Expert Midwife Low Intervention Births | DMMBIf I had preeclampsia during my last pregnancy, what can I do for my next pregnancy to help avoid that and avoid another early, c-section delivery? 

The hard truth is that having children teaches us that there are many things that happen in life that are outside of our control. The best thing you can do to try to avoid pre-eclampsia is to normalize your weight prior to pregnancy and keep your weight gain within a healthy range. Some evidence suggests that a diet with at least 60 grams of protein a day can also help. Develop a habit of regular exercise prior to pregnancy and continue during pregnancy. Also, find a provider who supports vaginal birth after cesarean and has a good track record with success. Remember, you are an experience mother who has been through a very tough pregnancy and birth. No matter how it goes, you are strong. Build a great support system around you and face a new pregnancy with courage.

What are your feelings on “pushing too soon.” As in, when I told my team I was ready to push and they said I was dilated to a four — they told me absolutely not to because I could rupture my cervix. It scared me to death and I lost my desired birth plan (not worried or upset at all- healthy baby boy) but I got an epidural because I couldn’t stop my body wanting to push. I have read conflicting opinions that cervical rupture is a risk but also that my body could’ve progressed quickly to catch up had I kept pushing. I would love some insight as we pray about going for round two.  

The urge to push early in labor is a common one. It indicates that your nerves that control the urge to push were being stimulated by labor and pressure from the baby.  While cervical rupture is rare, cervical edema can occur with early pushing and can slow labor progress. For some women, they can reduce to pushing to a weak grunt at the top of the contraction. For others, their body is pushing like a freight train and there is nothing they can do to diminish it. It is easy to second-guess your decision to have the epidural, but that approach fails to honor your ability to make good decisions for yourself. The best birth plan is the one that matches your labor. That means you must trust yourself to make changes as your labor unfolds. The other good news I have for you is that second babies tend to be very kind to you. Gather your courage.  You may be in for a much better experience the second time. 

With my first daughter, I ran into problems when I started pushing long before I was fully dilated. She was so low and engaged so early on, that I felt that uncontrollable urge to push way before I should. When I was told to stop pushing, it really threw me off my game! What advice do you have to hopefully prevent that from happening again with baby #2?

That uncontrollable urge to push does not necessarily happen with the next pregnancy.  One theory of early urge to push is fetal position. Do some reading about optimal fetal positioning and do what you can to encourage your baby to assume an optimal position for birth. You might want to look at spinningbabies.com. Build a birth team that will help you to maintain confidence. Find a great midwife or midwife practice that supports low intervention birth. Get a fabulous doula who will give you that contraction by contraction total focus and support.  First babies tend to be epic. Second babies tend to be kind to you. You have a great chance of having a very sweet birth.

Legal disclaimer: By reading this article, you agree not to use the information contained within this article as medical advice to treat any medical condition in either yourself or others. Consult your own physician for any medical issues that you may be having. This article does not constitute the practice of any medical, nursing or other professional health care advice, diagnosis or treatment. None of the sponsors or contributors to this article represent or warrant that any particular service or product is safe, appropriate or effective for you. Furthermore, this article should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on this article. Under no circumstances shall any sponsors or contributors to the article be responsible for damages arising from use of the article.

 

Molly Yeoman, CNM is a midwife at the UCHealth Center for Midwifery and practices at the Anschutz Medical Campus and Lone Tree locations.

Molly began her career with a Bachelors degree in Nursing from Villa Maria College in Erie, Pennsylvania. She then completed her Master of Science in Nursing with a focus on perinatal nursing at the University of Colorado while working on the labor and delivery unit at University of Colorado Hospital. 

Molly moved to Rochester, New York where she worked in hospital administration and nursing education and received a postgraduate certificate in midwifery from Frontier Nursing University in 1997. Since then, she has worked as a certified nurse-midwife in community hospitals, large teaching hospitals, birth centers, as well as in midwifery education.

Molly and her husband Tom returned to Colorado in 2011. They have four grown children, three whom live in Denver and one in Washington DC. Molly and Tom enjoy live music, hiking, yoga and travel. Molly is thrilled to be back in Colorado and working at UCHealth University of Colorado Hospital again with the Center for Midwifery.

 

 The UCHealth Center for Midwifery has three clinic locations throughout the Metro Denver area and delivers babies at University of Colorado Hospital. The Center for Midwifery is the only practice in the Metro Denver area that offers an in-hospital water birth option. To learn more or to schedule an appointment, please call 720-848-1700.

 

Clinic locations:

UCHealth Center for Midwifery – Anschutz Medical Campus
UCHealth Center for Midwifery – Lone Tree
UCHealth Center for Midwifery — Lowry

 

 

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