Midwifery Care Available In Hospitals For Pregnant Women In New York, New Jersey

Midwifery Care Available In Hospitals For Pregnant Women In New York, New Jersey

Pregnancy care has entered into a more holistic sphere at some hospitals in the tri-state area. We sat down with an OB/Gyn and a Certified Nurse Midwife who both practice at NYU Langone. Readers may remember our interview with their cardiologist about prevention of heart disease and things everyone can do.

When people think of childbirth, they almost invariably imagine a hospital setting. Considering that 98.4% of births occur in hospitals, this is definitely a correct picture. However, recent years have seen many changes in this healthcare field. At NYU, they have been moving to a more holistic, patient centered approach in many fields, but perhaps it can be seen most obviously in the Labor and Delivery area.

At this medical center, they have removed the old style, traditional (read uncomfortable and difficult) labor beds with a new style of bed that allows a laboring woman to change positions as often as she likes, including if she’s had an epidural. In other centers, they are only offered the option of laboring on their back with their legs tilted up so they are fighting the force of gravity.

Dr. Chuang said the following about the new beds:

“Labor and delivery labor beds with squat bar.

We have labor beds with a removable metal bar called a “squat bar” that can be attached to the bed to help with squatting and pushing:

Squatting: can help with pushing and expand the pelvis. Gravity can also help move the baby downward.

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Comfort: The bar can be adjusted so the mother can relax between contractions or pushes.

Epidural: The squat bar can usually be used even if the mother has an epidural.

Can be used with and without epidural. ALL PATIENTS!”

So that’s the first difference. Additionally, anyone who is in labor can add a certified nurse midwife to their healthcare team, and the benefits of this cannot be overstated. There are so many ways in which a midwife just does things differently. Perhaps the most critical is patience. As long as the baby and mother are OK, the labor is allowed to continue without interventions. Of course when there is distress, a doctor is on hand to help.

But the truth is that well over 90% of pregnancies are normal, progress well, and have good outcomes for mom and baby.

Fear and How It Affects Childbirth

One of the topics we covered was the centrality of fear and expectations to negative outcomes. In the classic book Childbirth Without Fear by Grantly Dick Read, he discusses the expectation or fear of pain and its relation to the amount of pain actually experienced. He found that when pain was not expected, it did not manifest. As a result, when he helped women to understand that fear led to the pain, they had better outcomes including fewer interventions or surgical births.

Another aspect that was covered in this book but not in the interview was the religious perspective, where in the Judeo-Christian religions, adherents are taught that the punishment meted out for original sin was pain during labor and birth for the woman while the man would have to toil to produce food.

When the author brought this passage to biblical and Torah scholars, however, he learned that the two punishments are described in a similar way using the same word: toil or difficulty, but not pain. Consequently he realized that pain in childbirth is not the original punishment, but that labor is work. And it truly is work, but it doesn’t have to be painful.

Another book that I highly recommend to all pregnant women and their partners is The Birth Partner. It’s by Penny Simkin, famous author of What To Expect When You’re Expecting, and it goes into great detail about what happens to the body step by step during labor. It was in this book that I learned that the uterus is the strongest muscle in the whole body.

Epidural Can Be The Key

One of the main drivers of interventions is the epidural. Most people aren’t aware that this medication consists of fentanyl and lidocaine or novocaine. Is this the fentanyl responsible for so many overdose deaths in America?

Yes, that fentanyl.

Of course, being fentanyl, it is a very strong drug. One that each woman will react differently to. So many laboring mothers react negatively to it, and this becomes an emergency in itself. For example, some of the side effects of fentanyl include maternal fever, neonatal fever, irregular heartbeat of mother or of baby. Every one of these side effects can become an emergency requiring surgical or vacuum removal of the fetus. This is because these effects can also indicate infection, and there’s no way to know if there is infection, so they treat it as if there is. Many c-sections occur for this reason.

One thing that midwife are very helpful with is avoiding unnecessary interventions. We can say unnecessary because there are interventions that are necessary and life saving when administered properly. However, most people, when given the opportunity and support, can labor without an epidural. This small change can have a big impact, not the least of which because then she can push more effectively. Instead of being numb in the area, she has full feeling. There are also medications other than epidural that can numb pain, such as nitrous oxide. That one is also much less likely to cause side effects.

Midwives are an essential part of the healthcare team. As licensed clinicians, they can also provide certain interventions and deliver the baby itself. Other professionals, such as doulas, while helpful, cannot deliver the baby or give interventions.

Looking At The Numbers

When we look at midwifery care and how effective it can be in preventing interventions and improving birth outcomes, statistics from the Midwives Alliance of North America showed a 5% C-section rate among  births with similarly lower rates for medications and other treatments.  Nationwide, the variable C-section rate averages about 30%.

In the case of this hospital (NYU), their midwife program provides them with a c-section rate of about 20%, which is less than the average of 30% in this area. The rate among Orthodox Jewish women is lower, at around 12%. This is because every intervention planned for an orthodox mother must be approved by her rabbi, and they must be sufficiently justified in his eyes in order for them to be allowed. That extra step and extra set of eyes on the data clearly has an effect on the rate.

Here you can see the summary from MONA detailing the rates of each intervention

Preparing For The Best Possible Birth

I wanted to discuss one more subtopic, and that is education. Every pregnant woman should prepare herself with sufficient education so that she goes into the hospital with eyes open. She should be a participant in her own healthcare process, not just a spectator.

Preparation can consist of a few things. First of all, exercise. Every day. Go for walks outside, go to the gym, do yoga or pilates every day or nearly so. This keeps your body flexible and your muscles supple. This can help the baby come out more easily.

Second, take a birth education class. Lamaze and Bradley method oriented classes are consistently rated as the most helpful types, but even going to your hospital’s class is better than not going at all. These classes teach you what to expect and, most importantly, how to relax when the contractions come. Notice how I didn’t say when the pain comes. This is because contractions aren’t usually painful…unless you fight them. If you completely relax into it, you’ll have a better feeling and outcome (this is not necessarily true for everyone- there are times contractions cause pain such as when the baby is pressing on the spine, etc).

Third, there are a few books you should read, and your partner or support person should also read one of them. The Birth Partner by Penny Simkin is recommended for both the pregnant person and her partner. You’ll learn an incredible amount about what’s happening and how the whole process works.

Childbirth Without Fear by Grantly Dick Read is also extremely helpful, as is Ina May’s Guide To Childbirth. Ina May Gaskin was one of the pioneers bringing midwifery back from the brink of destruction. She also worked heavily with the Amish population.

Most people don’t know that midwifery was literally illegal across the US through the 1980s and later, and it was only a strong public campaign that caused its revival. Now most states allow it to be practiced (but only by licensed nurses or other professions – where in the past it was an apprenticeship type of career). Most states don’t allow apprenticeship for midwifery, but at least it’s legal. And it’s growing in popularity.

In England, Australia, and Canada, nearly all births are attended by midwives. Their maternal mortality rates are also lower than ours. Canada has a rate of 11 per 100k births, while the US has the highest rate among all high income countries at a rate of 22 per 100k births.

Some states, including Louisiana and Alabama, whose recent total abortion bans have exacerbated the issue, have maternal mortality rates closer to 40 or 44 per 100k births, much higher than in other countries. And unfortunately, as Shawna mentioned, it is getting higher.

Midwifery Care can also indirectly lower this mortality rate by providing better care with better outcomes for mother and baby. It’s known to do this already, and as it’s adopted more universally, it will give more benefits to mothers across the country.

While this interview was about midwifery in NYU Langone-Brooklyn, there are other local hospitals with midwifery programs. Staten Island University Hospital, Saint Peter’s Hospital near Princeton (also an excellent overall maternity care program), Valley Health System, and some Barnabas locations have midwife programs.

If you want to have the best chance of reduced interventions, a free-standing birth center, while more costly, can be the most comfortable option. Rooms are more like hotel rooms, and they have a staff of midwives, doulas, and OBs to provide the best care possible. In both New York and New Jersey, every birth center must be within five minutes of a hospital with a NICU.

Birth Centers of NJ and Midwives of New Jersey all have excellent reputations and a great staff if you want that type of experience.

Baby Friendly and Mother Friendly Certifications

Always look for a hospital that holds both of these certifications. When they are present, that means a hospital is dedicated to taking necessary steps to improve their program in line with the rigorous standards set forth. While it is not a guarantee, a hospital with these certifications and a midwife program is going to give you the most satisfying birth experience.

Banner Image: Video cover. Image Credit – NYU Langone