International Day of the Midwife: What Makes a Birth Center Unique
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May 5th is the International Day of the Midwife. Hosted by the International Confederation of Midwives (ICM), the organization is leading efforts to address the global maternal mortality crisis by positioning midwives as fundamental to the care of mother and child.
The theme of the 2021 International Day of the Midwife is “Follow the Data: Invest in Midwives.” And what does the data tell us?
Maternal mortality is not just a problem in the developing world. Maternal deaths have steadily increased in the United States over the past 25 years to the point that it has become a public health crisis. And while all women are at greater risk, Black, Alaskan Native, and Native American women are three times more likely to die as a result of complications from pregnancy and childbirth than their white counterparts. Higher rates of maternal death have also been found among women experiencing poverty.
Perhaps the most alarming aspect of this crisis is that the Center for Disease Control (CDC) has deemed six out of every 10 maternal deaths preventable. The International Confederation of Midwives (ICM) views midwifery care as a vital part of ending preventable maternal and newborn death. Efforts by ICM and collaborators align with United Nations Sustainable Development Goal 3.1, which aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030 (WHO 2021).
A recent study published in Lancet Global Health found that educated, trained midwives who are regulated by global standards play an integral role in reducing maternal mortality. In fact, with even a modest 10 percent increase in midwifery-care coverage every five years, 1.3 million lives could be saved annually. Implementing universal coverage of midwifery care by 2035 has the potential to save almost three times that number, averting 67 percent of maternal, 64 percent of newborn, and 65 percent of stillborn deaths. This amounts to 4.3 million lives saved globally per year within the same time frame.
What Are The Different Kinds of Midwives?
The International Confederation of Midwives (ICM) defines the midwife as:
A person who has successfully completed a midwifery education programme that is duly recognized in the country where it is located and that is based on the ICM Essential Competencies for Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education; who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery and use the title ‘midwife’; and who demonstrates competency in the practice of midwifery.
There are three national midwifery credentials in the United States: certified midwives (CMs), certified professional midwives (CPMs), and certified nurse-midwives (CNMs). Differences between the three include education requirements, range of care, prescriptive authority, practice setting, and certification criteria, among others.
CNMs and CMs are typically employed in hospitals, health clinics, and birth centers. CPMs attend the majority of home births and may also be employed at birth centers. Despite the common thread of midwifery care found across practice settings, labor and birth can be quite different depending upon where a family chooses to bring their child into the world.
In honor of the International Day of the Midwife, AlexAnn Westlake, executive director of Our Community Birth Center, spoke with us about what to expect when choosing midwifery care at a birth center versus at home or in a hospital setting.
Interview With AlexAnn Westlake, Certified Nurse Midwife
AlexAnn Westlake is the executive director of Our Community Birth Center in Lane County, Oregon and a certified nurse-midwife. She has experience in several full-scope nurse-midwifery practice settings including Shenandoah Women’s Healthcare in Harrisonburg, Virginia and PeaceHealth Nurse Midwifery Birth Center in Springfield, Oregon.
Ms. Westlake earned degrees in registered nursing (BSN) and nursing-midwifery (MN) at Oregon Health Sciences University. She also holds a bachelor’s in Spanish language and literature from the University of Oregon.
One of the main benefits of birth center services administered by certified nurse-midwives (CNMs) is women’s healthcare. This may include a variety of healthcare services beginning prior to pregnancy and continuing well beyond the childbearing years. Women’s healthcare is also available for women choosing not to have children. Birth center women’s healthcare services may include family planning, STI testing, annual exams, prenatal care, labor and birth, and postnatal care for mothers and infants.
Westlake explained that this can be a particularly impactful experience for women who choose to receive care prior to and through pregnancy and birth at a full-scope nurse-midwifery birth center. She related the story of a client that received care at the birth center prior to pregnancy, through a miscarriage, and during a subsequent full-term pregnancy: “That was really important to her, that she had gotten to know the space and the people that worked there and developed those relationships before even her pregnancy and birth,” Westlake said.
In addition to women’s healthcare, other services provided at a full-scope nurse-midwifery birth center practice may include:
- General healthcare
- All options pregnancy counseling
- Pregnancy care
- Labor and birth care in the birth center
- Newborn care
- Postpartum care
- Postpartum home-visits
- Lactation services
- Family planning and contraception
- Preventative healthcare
- LGBTQIA+ healthcare
- Lab testing
- Medication prescriptions
- Weekly baby clinic for feeding advice and peer support
- Childbirth education classes
- Lactation classes
Community, Connection, Comfort
Another aspect of birth center care is that it can feel less “medical” than a clinic or hospital-based midwifery practice. This is due to smaller staff sizes and the comfortable home-like space that characterizes the birth center atmosphere.
“It can feel more medical going to other types of clinics,” Westlake shared, “even the hospital midwifery practice [may] feel more medical, just in the environment.”
When a person in labor arrives at a hospital-based midwifery practice, she said, “They don’t know who their nurse is going to be, they probably don’t know who their doctor’s going to be, they may or may not know who their midwife is going to be … and they definitely don’t know what room they’re going to be in.”
The effects of all of these unknowns can go beyond the social-emotional to impact the physical act of labor and delivery itself:
Something that we do see happen in labor is … hormones can get thrown off pretty easily if someone scares you or something makes you feel uncomfortable. So even just going from home to the hospital, someone could be laboring really well at home, making progress, and then they arrive at the hospital and labor slows down … Sometimes you come into this new environment, and then things slow down because your body’s like, “Woah, where am I? What’s going on?”
A particularly unique aspect of the birth center experience is that families are getting their prenatal care in the same space where they’re going to give birth. This can put people at ease. Even though a birth center has waiting rooms and clinic rooms as in other healthcare settings, “People really like that they’re coming to this home-like space” Westlake shared. The spaces are intentionally designed to be comfortable and warm. Families get familiar with the environment during the course of their care.
Additionally, birth centers have other practices that add to the sense of comfort and connection families report experiencing. When first accessing the center, for example, the staff provides an orientation and tour. This is standard practice for every patient and family expressing interest in the birth center:
“We give that opportunity for people to see the space, see how it feels, ask the midwife questions, and then they can choose to sign up for their first appointment depending on what they would like to do,” Westlake explained.
Westlake added that appointment times are also typically a little longer in a birth center setting, too, in part due to the shared decision-making that characterizes the care offered.
There is a big emphasis on shared decision-making in a nurse-midwifery birth center practice. This is to encourage people to actively prepare for their birthing experience and support them through the process in an empowering way.
Westlake explained that a key component to this approach is “recognizing that I, as the midwife, don’t hold all of the important information. Each of my clients comes in with their own important goals and information and understanding of things.”
In the hospital setting, on the other hand, there are routine practices that are done for every person in labor. People are not always counseled, per se, on the options or even aware that they have a choice about what is being done in some cases.
In such cases, Westlake shared, a CNM at a birth center might say, “This is what we recommend, this is why we recommend it, may I do this?” However, in a hospital setting hospital policy dictates what is done and when, and this is often the same across the board, regardless of an individual’s health profile.
In a labor and delivery scenario, an example of this is the practice of immediately starting an IV when a person comes in to give birth. While this is standard procedure at a hospital, a birth center would only do so if that were indicated by the presence of a specific health condition, such as a history of excessive bleeding after birth or the group b strep bacteria, in which case the CDC recommends antibiotics during labor.
Westlake explained, “If there was a risk factor that would make it a good idea to put in an IV, then it’s something that we would have already talked about during the pregnancy … and they would come expecting it and knowing … as opposed to just doing it for everybody.”
A women’s healthcare example of where shared-decision making could come into play is with pap smears. At a birth center appointment, a CNM might explain what a pap smear is, show the patient a speculum, explain the process and the reasons for it, the pros and cons, and why it might be recommended. The CNM might also provide alternative options. Hence, the longer appointment times. A lot of questions are asked and answered and a lot of information is discussed in a typical birth center women’s healthcare appointment.
“I do definitely make recommendations,” Westlake was quick to add, “but leaving room for people to make their own decisions.”
Midwifery Advocacy and Resources
Learn more about the impact of midwifery care around the globe. The following resources and events are leading current and future advocacy efforts:
Sponsored by the International Confederation of Midwives (ICM), the day coincides with the launch of the 2021 State of the World’s Midwifery Report (SoWMy), providing the latest, evidence-based analysis of midwifery practice across the globe.
Set to be the largest virtual gathering of midwives ever, this event will take place each Monday in June with opportunities to learn and network with industry leaders committed to the future of the midwifery profession. The event will kick off on June 2nd with a panel discussion of the 2021 State of the World’s Midwifery Report.
Released in 2020, this study was led by the United Nations Population Fund (UNFPA), the International Confederation of Midwives (ICM), and the World Health Organization (WHO).
Hosted by the Wilson Center, this event featured key quotes from global leaders on the life-saving impact of midwives based on the most recent Impact of Midwives Study.
Learn about the need for trained midwives and how they can impact maternal mortality and care through this publication of the UNFPA.
Scheduled to be launched right before the International Day of the Midwife on May 5th, the GMH will include advocacy support for midwives and online data resources to promote exchange and collaboration in support of autonomous midwives.
Cevia Yellin is a freelance writer based in Eugene, Oregon. She studied English and French literature as an undergraduate. After serving two years as an AmeriCorps volunteer, she earned her master of arts in teaching English to speakers of other languages. Cevia’s travels and experiences working with students of diverse linguistic and cultural backgrounds have contributed to her interest in the forces that shape identity. She grew up on the edge of Philadelphia, where her mom still lives in her childhood home.